Provider Demographics
NPI:1699925875
Name:EVERETT, ELIZABETH HOLMES (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HOLMES
Last Name:EVERETT
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 1:215 RONNIE CT STE C
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4204
Mailing Address - Country:US
Mailing Address - Phone:843-894-0000
Mailing Address - Fax:843-589-9054
Practice Address - Street 1:215 RONNIE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4204
Practice Address - Country:US
Practice Address - Phone:843-894-0000
Practice Address - Fax:843-589-9054
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061131041C0700X
SC64131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical