Provider Demographics
NPI:1437535705
Name:CASTLE, DR ELIZABETH ELIZA (BBA,MED,PCS)
Entity Type:Individual
Prefix:
First Name:DR ELIZABETH
Middle Name:ELIZA
Last Name:CASTLE
Suffix:
Gender:F
Credentials:BBA,MED,PCS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ELIZA
Other - Last Name:CASTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BBA, MED,PCS
Mailing Address - Street 1:1643 B SAVANNAH HIGHWAY STE 351
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:404-935-8722
Mailing Address - Fax:
Practice Address - Street 1:1527 SAM RITTENBERG BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4189
Practice Address - Country:US
Practice Address - Phone:404-935-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081515-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA081515-1OtherPARACLETOS COUNSELING SPECIALIST