Provider Demographics
NPI:1003249277
Name:CHALFANT, ELIZABETH R (LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:CHALFANT
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:WHIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9233
Mailing Address - Country:US
Mailing Address - Phone:740-788-8850
Mailing Address - Fax:740-788-8851
Practice Address - Street 1:14 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9233
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:740-522-4263
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1800951-SUPV1041C0700X
OHLICDC.162047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200008Medicaid