Provider Demographics
NPI:1366188617
Name:LIVINGSTON, ELIZA R (CHW)
Entity type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:R
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:R
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:3620 HUFFINES BLVD APT 2012
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6464
Mailing Address - Country:US
Mailing Address - Phone:469-831-5784
Mailing Address - Fax:
Practice Address - Street 1:3620 HUFFINES BLVD APT 2012
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6464
Practice Address - Country:US
Practice Address - Phone:469-831-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty