Basic Information
Provider Information
NPI: 1003292327
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ELDER
FirstName: MELISSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14620 BRICK CHURCH CT
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282773756
CountryCode: US
TelephoneNumber: 9802888595
FaxNumber:  
Practice Location
Address1: 3111 SPRINGBANK LN
Address2: SUITE G
City: CHARLOTTE
State: NC
PostalCode: 282263372
CountryCode: US
TelephoneNumber: 9802888595
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/10/2015
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X9043CTN Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700XC009689NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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