Provider Demographics
NPI:1982123980
Name:WARD, ELIZABETH (LCDCIII)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1343
Mailing Address - Country:US
Mailing Address - Phone:740-947-2364
Mailing Address - Fax:740-947-9379
Practice Address - Street 1:111. NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9443
Practice Address - Country:US
Practice Address - Phone:740-947-2364
Practice Address - Fax:740-947-9379
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty