Provider Demographics
NPI:1477397776
Name:ELIAS, CREIGHTON (LPC)
Entity type:Individual
Prefix:
First Name:CREIGHTON
Middle Name:
Last Name:ELIAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 NUCKOLS RD
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-3430
Mailing Address - Country:US
Mailing Address - Phone:404-561-2127
Mailing Address - Fax:
Practice Address - Street 1:87 NUCKOLS RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-3430
Practice Address - Country:US
Practice Address - Phone:404-561-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional