| Elizabeth R. Glaze, Lpc, Llc | |
|
1285 Marks Church Rd Ste B Augusta GA 30909-2472 | |
| (706) 288-5082 | |
| (706) 863-0941 |
| Full Name | Elizabeth R. Glaze, Lpc, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1285 Marks Church Rd Ste B, Augusta, Georgia |
| Authorized Official Name and Position | Elizabeth Ray Glaze (PRESIDENT) |
| Authorized Official Contact | 7062885082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth R. Glaze, Lpc, Llc Po Box 238 Appling GA 30802-0238 Ph: (706) 288-5082 | Elizabeth R. Glaze, Lpc, Llc 1285 Marks Church Rd Ste B Augusta GA 30909-2472 Ph: (706) 288-5082 |
| NPI Number | 1912283508 |
|---|---|
| Provider Enumeration Date | 10/26/2011 |
| Last Update Date | 10/26/2011 |
| Medicare PECOS PAC ID | 8628414430 |
|---|---|
| Medicare Enrollment ID | O20240319002371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912283508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC003774 (Georgia) | Primary |
| Provider Name | Elizabeth Ray Glaze |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790887206 PECOS PAC ID: 3173969987 Enrollment ID: I20240319002614 |
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