Provider Demographics
NPI:1992813638
Name:CHILDS, ELIZABETH B (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2971
Mailing Address - Country:US
Mailing Address - Phone:336-570-3739
Mailing Address - Fax:336-570-1215
Practice Address - Street 1:221 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2971
Practice Address - Country:US
Practice Address - Phone:336-570-3739
Practice Address - Fax:336-570-1215
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003238Medicaid
NCNCH699AMedicare UPIN