| Doctor Name: | MS. ELIZA A BOULWARE |
| NPI Number: | 1215275565 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 200 Calhoun St Winnsboro, SC - 291801508 |
| Business Phone Number: | 8036352335 |
| Business Fax Number: | 8036359695 |
| Mailing Address: | Po Box 388, WINNSBORO |
| State: | SC |
| Postal Code: | 291800388 |
| Phone Number: | 8036352335 |
| Fax Number: | 8036359695 |
| NPI Enumeration Date: | 01/22/2013 |
| NPI Last Update Date: | 01/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |