Provider Demographics
NPI:1154677581
Name:NEALLEY ANDREWS, ELISSA ASHTON (LCSW)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:ASHTON
Last Name:NEALLEY ANDREWS
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 1:2222 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7515
Mailing Address - Country:US
Mailing Address - Phone:910-343-8209
Mailing Address - Fax:910-343-8836
Practice Address - Street 1:1705 GARDNER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8873
Practice Address - Country:US
Practice Address - Phone:910-343-5300
Practice Address - Fax:910-482-5077
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical