Provider Demographics
NPI:1588129860
Name:LIGGETT, ELENA (LISW-CP)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LIGGETT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 COCKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2753
Mailing Address - Country:US
Mailing Address - Phone:803-528-3958
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK SUITE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6095
Practice Address - Fax:803-758-0120
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9539OtherSTATE OF SOUTH CAROLINA BOARD OF SOCIAL WORK- LLR