Provider Demographics
NPI:1770905341
Name:CALLAWAY, ELIZABETH (LCDC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CALLAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC
Mailing Address - Street 1:400 MANN ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2046
Mailing Address - Country:US
Mailing Address - Phone:361-814-2001
Mailing Address - Fax:361-883-1998
Practice Address - Street 1:400 MANN ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2046
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:361-883-1998
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8163101YA0400X
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)