Provider Demographics
NPI:1467849554
Name:COUDRIGHT, ELIZABETH CAROLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAROLE
Last Name:COUDRIGHT
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 1:2201 COURAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6733
Mailing Address - Country:US
Mailing Address - Phone:707-784-2201
Mailing Address - Fax:
Practice Address - Street 1:2201 COURAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6733
Practice Address - Country:US
Practice Address - Phone:707-784-2080
Practice Address - Fax:707-784-2103
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical