Provider Demographics
NPI:1124400312
Name:CUSH, ELIZABETH (LGPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CUSH
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BAY RIDGE AVE
Mailing Address - Street 2:GROUNDFLOOR
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3029
Mailing Address - Country:US
Mailing Address - Phone:410-340-8469
Mailing Address - Fax:
Practice Address - Street 1:915 BAY RIDGE AVE
Practice Address - Street 2:GROUNDFLOOR
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3029
Practice Address - Country:US
Practice Address - Phone:410-340-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional