Provider Demographics
NPI:1962454330
Name:KINCAID, ELIZABETH C (MED, NCC, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:C
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MED, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S ELM ST STE 311
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2636
Mailing Address - Country:US
Mailing Address - Phone:336-450-0606
Mailing Address - Fax:336-450-1596
Practice Address - Street 1:301 S ELM ST STE 311
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2636
Practice Address - Country:US
Practice Address - Phone:336-450-0606
Practice Address - Fax:336-450-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102009Medicaid