Provider Demographics
NPI:1568602183
Name:GOULD, ELISABETH CHRISTIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:CHRISTIE
Last Name:GOULD
Suffix:
Gender:F
Credentials:LAC
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Other - Credentials:
Mailing Address - Street 1:4080 CENTRE ST. SUITE 202
Mailing Address - Street 2:THRIVE WELLNESS INC.
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2655
Mailing Address - Country:US
Mailing Address - Phone:619-795-4422
Mailing Address - Fax:619-795-4423
Practice Address - Street 1:4080 CENTRE ST. SUITE 202
Practice Address - Street 2:THRIVE WELLNESS INC.
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2655
Practice Address - Country:US
Practice Address - Phone:619-795-4422
Practice Address - Fax:619-795-4423
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12625171100000X
CAAC12625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist