Provider Demographics
NPI:1942220025
Name:WITTER, ELIZABETH RAYANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:RAYANNE
Last Name:WITTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 COOMBS FARM ROAD
Mailing Address - Street 2:SUITE 106B
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508
Mailing Address - Country:US
Mailing Address - Phone:304-381-2211
Mailing Address - Fax:
Practice Address - Street 1:2000 COOMBS FARM ROAD
Practice Address - Street 2:SUITE 106B
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508
Practice Address - Country:US
Practice Address - Phone:304-381-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010815401041C0700X
WVDP009440981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical