Provider Demographics
NPI:1770359887
Name:GOWDY, ELIZABETH ANN (PHD, LISW-CP, MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:GOWDY
Suffix:
Gender:F
Credentials:PHD, LISW-CP, MSW
Other - Prefix:
Other - First Name:E
Other - Middle Name:ANN
Other - Last Name:GOWDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2744 W TURBEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-5321
Mailing Address - Country:US
Mailing Address - Phone:864-345-3070
Mailing Address - Fax:
Practice Address - Street 1:151 MCDONALD CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6134
Practice Address - Country:US
Practice Address - Phone:843-294-0646
Practice Address - Fax:843-294-0318
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical