Provider Demographics
NPI:1558559955
Name:VAN HORN, ELIZABETH JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WINDEL DRIVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-904-4651
Mailing Address - Fax:888-789-5440
Practice Address - Street 1:111 WINDEL DR
Practice Address - Street 2:SUITE 213
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4475
Practice Address - Country:US
Practice Address - Phone:919-904-4651
Practice Address - Fax:888-789-5440
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist