Provider Demographics
NPI:1871816009
Name:ELIAS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 DUKE ST # 270
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-4403
Mailing Address - Country:US
Mailing Address - Phone:843-255-6005
Mailing Address - Fax:843-757-6581
Practice Address - Street 1:1905 DUKE ST # 270
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-4403
Practice Address - Country:US
Practice Address - Phone:843-255-6005
Practice Address - Fax:843-525-0404
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid