Provider Demographics
NPI:1427188325
Name:JEWELL, ELIZABETH DONNA (RN,CFAE,CSAC,CCS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DONNA
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RN,CFAE,CSAC,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E WATER ST
Mailing Address - Street 2:BEHAVIORAL HEALTH SERVICES
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1450
Mailing Address - Country:US
Mailing Address - Phone:252-943-2111
Mailing Address - Fax:252-944-2207
Practice Address - Street 1:202 E WATER ST
Practice Address - Street 2:BEHAVIORAL HEALTH SERVICES
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1450
Practice Address - Country:US
Practice Address - Phone:252-943-2111
Practice Address - Fax:252-944-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCCS 42 CSAC 834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110545Medicaid