Provider Demographics
NPI:1083327977
Name:GORE, ELIZABETH PORTER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:PORTER
Last Name:GORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 CASEY ST
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2910
Mailing Address - Country:US
Mailing Address - Phone:843-333-2587
Mailing Address - Fax:
Practice Address - Street 1:3708 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2910
Practice Address - Country:US
Practice Address - Phone:843-333-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6325101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor