Provider Demographics
NPI:1124378344
Name:SCHENCK, ELIZA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:R
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:RAGSDALE
Other - Last Name:SCHENCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2000 PISGAH CHURCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3311
Mailing Address - Country:US
Mailing Address - Phone:336-288-6165
Mailing Address - Fax:336-288-6744
Practice Address - Street 1:2000 PISGAH CHURCH RD STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3311
Practice Address - Country:US
Practice Address - Phone:336-288-6165
Practice Address - Fax:336-288-6744
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical