Provider Demographics
NPI:1679557631
Name:ARNOLD, ELIZABETH MAYFIELD (LCSW PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAYFIELD
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LCSW PHD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:245 FOUNTAIN CT STE 225
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2794
Practice Address - Country:US
Practice Address - Phone:859-323-6021
Practice Address - Fax:859-323-1670
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0037321041C0700X
KY2571351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002787Medicaid
129VPOtherBCBS
43331OtherPARTNERS
D2411OtherMEDCOST
NC6002787Medicaid
D2411OtherMEDCOST
NC2873540BMedicare PIN