Provider Demographics
NPI:1962527408
Name:POLOMIK, ELIZABETH MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:POLOMIK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:DOGAER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3520 PRITCHARD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8973
Mailing Address - Country:US
Mailing Address - Phone:919-266-9010
Mailing Address - Fax:919-747-4172
Practice Address - Street 1:8510 SIX FORKS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3257
Practice Address - Country:US
Practice Address - Phone:919-602-8572
Practice Address - Fax:919-747-4172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103070Medicaid