Provider Demographics
NPI:1801263181
Name:EARHART, ELIZABETH (MS,LPC; MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EARHART
Suffix:
Gender:F
Credentials:MS,LPC; MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-0219
Mailing Address - Country:US
Mailing Address - Phone:404-386-4477
Mailing Address - Fax:
Practice Address - Street 1:245 W WIEUCA RD NE STE 150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3369
Practice Address - Country:US
Practice Address - Phone:404-631-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004814101YP2500X
GASLP006268235Z00000X
GALPC010203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist