Provider Demographics
NPI:1023892536
Name:LILES, ELIZABETH KEAIS (MSW, LCAS-A)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KEAIS
Last Name:LILES
Suffix:
Gender:F
Credentials:MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2494
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-0494
Mailing Address - Country:US
Mailing Address - Phone:252-375-9712
Mailing Address - Fax:
Practice Address - Street 1:1704 E ARLINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-7828
Practice Address - Country:US
Practice Address - Phone:252-756-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0196031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical