Provider Demographics
NPI:1083297873
Name:ELLER, DORA
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4225
Mailing Address - Country:US
Mailing Address - Phone:910-491-8934
Mailing Address - Fax:910-491-7119
Practice Address - Street 1:2038 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4225
Practice Address - Country:US
Practice Address - Phone:910-491-8934
Practice Address - Fax:910-491-7119
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0161551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical