Provider Demographics
NPI:1255698668
Name:STRADFORD, ELIZABETH M
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:STRADFORD
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:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-0182
Mailing Address - Country:US
Mailing Address - Phone:803-549-0900
Mailing Address - Fax:
Practice Address - Street 1:1381 JAMES WEST LN
Practice Address - Street 2:
Practice Address - City:CASSATT
Practice Address - State:SC
Practice Address - Zip Code:29032-9421
Practice Address - Country:US
Practice Address - Phone:803-549-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor