Provider Demographics
NPI:1326150921
Name:WHATLEY, ELISABETH WOODS (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:WOODS
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 MISTY FOREST PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2530
Mailing Address - Country:US
Mailing Address - Phone:704-786-1796
Mailing Address - Fax:
Practice Address - Street 1:608 MCCOMBS AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3605
Practice Address - Country:US
Practice Address - Phone:704-933-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical