Basic Information
| Provider Information | |||||||||
| NPI: | 1104570464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUTTING | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ME.D, ADC-IP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 GEORGE BISHOP PKWY | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295797335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434922268 | ||||||||
| FaxNumber: | 8439035432 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 GEORGE BISHOP PKWY | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295797335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434922268 | ||||||||
| FaxNumber: | 8439035432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2022 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | SC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.