Provider Demographics
NPI:1114194354
Name:ACOSTA, ELBA IRIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:IRIS
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MCCULLOUGH DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1336
Mailing Address - Country:US
Mailing Address - Phone:980-216-6899
Mailing Address - Fax:704-909-2725
Practice Address - Street 1:301 MCCULLOUGH DR STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1336
Practice Address - Country:US
Practice Address - Phone:980-216-6899
Practice Address - Fax:704-909-2725
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076051104100000X
NCP0112721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY076051OtherLICENSE
NCC013838OtherLCSW LICENSE
NCP011272OtherLICENSE