Provider Demographics
NPI:1093867285
Name:FAULKNER, ELIZABETH ANN (EDD, LISAC LPC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:EDD, LISAC LPC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD, LISAC LPC
Mailing Address - Street 1:1323 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-3407
Mailing Address - Country:US
Mailing Address - Phone:520-426-9540
Mailing Address - Fax:520-836-9016
Practice Address - Street 1:425 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4635
Practice Address - Country:US
Practice Address - Phone:520-426-9540
Practice Address - Fax:520-836-9016
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10566101YA0400X
AZLPC 12503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional