Provider Demographics
NPI:1083091300
Name:PERRY, ELIZABETH R (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E MAIN ST STE C14
Mailing Address - Street 2:PMB 104
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-2653
Mailing Address - Country:US
Mailing Address - Phone:864-569-6375
Mailing Address - Fax:
Practice Address - Street 1:115 ALBERTA DR
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-9133
Practice Address - Country:US
Practice Address - Phone:864-569-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC6121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)