Provider Demographics
NPI:1801451497
Name:LAINE, ELAINE SNOW (LISWCP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:SNOW
Last Name:LAINE
Suffix:
Gender:F
Credentials:LISWCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-6158
Mailing Address - Country:US
Mailing Address - Phone:843-860-7133
Mailing Address - Fax:
Practice Address - Street 1:3101 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:SEABROOK ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-6158
Practice Address - Country:US
Practice Address - Phone:843-860-7133
Practice Address - Fax:843-282-7706
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW.9041CP1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical