Provider Demographics
NPI:1043980659
Name:YEGGE, ELIZABETH H
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:H
Last Name:YEGGE
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 1:100 STONE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6588
Mailing Address - Country:US
Mailing Address - Phone:803-373-1159
Mailing Address - Fax:
Practice Address - Street 1:100 STONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6588
Practice Address - Country:US
Practice Address - Phone:803-373-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4688103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool