Provider Demographics
NPI:1962743997
Name:BARNARD, ELIZABETH BROOKE
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:BROOKE
Last Name:BARNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 BRYANSPLACE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-5006
Mailing Address - Country:US
Mailing Address - Phone:336-745-1373
Mailing Address - Fax:
Practice Address - Street 1:3504 VEST MILL RD
Practice Address - Street 2:SUITE 28
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2985
Practice Address - Country:US
Practice Address - Phone:336-745-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional