Individual
MRS. ELISABETH MARIE CORNACCHIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2100 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5832
(843) 852-4100
Mailing address
1510 WATERS PL, BRONX, NY 10461-2700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
8781
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760596480
—
SC
Enumeration date
05/01/2018
Last updated
01/17/2024
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