Provider Demographics
NPI:1770688012
Name:PRINCE, ELIZABETH MORRIS (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MORRIS
Last Name:PRINCE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 TANNER ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3207
Mailing Address - Country:US
Mailing Address - Phone:770-834-5062
Mailing Address - Fax:770-834-1865
Practice Address - Street 1:309 TANNER ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3207
Practice Address - Country:US
Practice Address - Phone:770-834-5062
Practice Address - Fax:770-834-1865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC2579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional