Provider Demographics
NPI:1215016530
Name:DIVVER, ELIZABETH J (MSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:DIVVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BONHAM CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5502
Mailing Address - Country:US
Mailing Address - Phone:864-844-8019
Mailing Address - Fax:864-328-3210
Practice Address - Street 1:616 BONHAM CT
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5502
Practice Address - Country:US
Practice Address - Phone:864-844-8018
Practice Address - Fax:864-328-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39002Medicare UPIN
8132Medicare PIN