Provider Demographics
NPI:1649864620
Name:ISHOLA, ELIZABETH DAMILOLA (NCC, BC-TMH, LCMHCA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAMILOLA
Last Name:ISHOLA
Suffix:
Gender:F
Credentials:NCC, BC-TMH, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 RIVERWOOD CIR APT 336
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5758
Mailing Address - Country:US
Mailing Address - Phone:813-440-0962
Mailing Address - Fax:
Practice Address - Street 1:4505 FAIR MEADOWS LN STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6449
Practice Address - Country:US
Practice Address - Phone:984-204-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health