Provider Demographics
NPI:1003146499
Name:URBAN, ELIZABETH A (MAPC, LPC, NBCC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:URBAN
Suffix:
Gender:F
Credentials:MAPC, LPC, NBCC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:RICARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAPC, LPC, NBCC
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164-0505
Mailing Address - Country:US
Mailing Address - Phone:803-234-1213
Mailing Address - Fax:
Practice Address - Street 1:227 BROWNS POND RD BLDG ROOM4
Practice Address - Street 2:
Practice Address - City:SALLEY
Practice Address - State:SC
Practice Address - Zip Code:29137-9054
Practice Address - Country:US
Practice Address - Phone:503-234-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7499101YP2500X
KYLPCPCC00222652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100368520Medicaid