Provider Demographics
NPI:1790887206
Name:GLAZE, ELIZABETH RAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RAY
Last Name:GLAZE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-0238
Mailing Address - Country:US
Mailing Address - Phone:706-288-5082
Mailing Address - Fax:706-863-0941
Practice Address - Street 1:1105 FURYS LN STE D
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8238
Practice Address - Country:US
Practice Address - Phone:706-288-5082
Practice Address - Fax:706-863-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional