Provider Demographics
NPI:1154643591
Name:COULTHRUST, ELDA-ROSA (LCAS, LCMHC)
Entity Type:Individual
Prefix:
First Name:ELDA-ROSA
Middle Name:
Last Name:COULTHRUST
Suffix:
Gender:F
Credentials:LCAS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10936 MCCAMIE HILL PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9153
Mailing Address - Country:US
Mailing Address - Phone:980-202-0606
Mailing Address - Fax:
Practice Address - Street 1:10936 MCCAMIE HILL PL
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9153
Practice Address - Country:US
Practice Address - Phone:980-202-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8640101YM0800X
NC1562101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health