Provider Demographics
NPI:1669851184
Name:BOULOS, ELIZABETH LAUREN (LCAS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:BOULOS
Suffix:
Gender:F
Credentials:LCAS, LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:179 AMETHYST CIR
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1135
Mailing Address - Country:US
Mailing Address - Phone:828-242-1007
Mailing Address - Fax:
Practice Address - Street 1:179 AMETHYST CIR
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-1135
Practice Address - Country:US
Practice Address - Phone:828-242-1007
Practice Address - Fax:828-641-9242
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21450101YA0400X
NCC0116011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)