Provider Demographics
NPI:1679398168
Name:HARRELSON, ELIZABETH (LPES)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:LPES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 2ND LOOP RD STE 9
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6180
Mailing Address - Country:US
Mailing Address - Phone:843-992-0009
Mailing Address - Fax:
Practice Address - Street 1:722 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5724
Practice Address - Country:US
Practice Address - Phone:843-992-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty