Provider Demographics
NPI:1780961961
Name:GARDNER, ELIZABETH S (MSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2120
Mailing Address - Country:US
Mailing Address - Phone:252-433-0300
Mailing Address - Fax:252-433-8054
Practice Address - Street 1:109 N GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4637
Practice Address - Country:US
Practice Address - Phone:252-433-0300
Practice Address - Fax:252-433-8054
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)