Provider Demographics
NPI:1710463674
Name:NEELY, ELIZABETH JOLLY (ED S, LPC, FMCHC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JOLLY
Last Name:NEELY
Suffix:
Gender:F
Credentials:ED S, LPC, FMCHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1946
Mailing Address - Country:US
Mailing Address - Phone:864-266-4339
Mailing Address - Fax:
Practice Address - Street 1:561 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1946
Practice Address - Country:US
Practice Address - Phone:864-266-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5156101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health