Provider Demographics
NPI:1740474717
Name:YORK, ELIZABETH FAIR (PHD, MT-BC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FAIR
Last Name:YORK
Suffix:
Gender:F
Credentials:PHD, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 E MAIN ST
Mailing Address - Street 2:CONVERSE COLLEGE
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1931
Mailing Address - Country:US
Mailing Address - Phone:864-596-9166
Mailing Address - Fax:864-596-9167
Practice Address - Street 1:580 E MAIN ST
Practice Address - Street 2:CONVERSE COLLEGE
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1931
Practice Address - Country:US
Practice Address - Phone:864-596-9166
Practice Address - Fax:864-596-9167
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT04459171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor