Provider Demographics
NPI:1982794194
Name:OWEN, ELIZABETH CECELIA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CECELIA
Last Name:OWEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 ROYAL BONNET CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8367
Mailing Address - Country:US
Mailing Address - Phone:910-793-4852
Mailing Address - Fax:
Practice Address - Street 1:1213 CULBRETH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3684
Practice Address - Country:US
Practice Address - Phone:910-256-5527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2655103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC045GWOtherPSYCHOLOGIST
NC045GWOtherPSYCHOLOGIST