Provider Demographics
NPI:1013493667
Name:CONDYLES, ELIZABETH S (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:CONDYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1833
Mailing Address - Country:US
Mailing Address - Phone:804-516-2499
Mailing Address - Fax:
Practice Address - Street 1:4506 STUART AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-1833
Practice Address - Country:US
Practice Address - Phone:804-516-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional