Provider Demographics
NPI:1417628983
Name:VAZQUEZ, ELIZABETH C (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:VAZQUEZ
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 1:444 TOBACCO FARM WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-0458
Mailing Address - Country:US
Mailing Address - Phone:919-744-7402
Mailing Address - Fax:
Practice Address - Street 1:444 TOBACCO FARM WAY
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-0458
Practice Address - Country:US
Practice Address - Phone:919-744-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0089311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical