Provider Demographics
NPI:1164812632
Name:ELEAZER, VERNETTA LEE (MS, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:VERNETTA
Middle Name:LEE
Last Name:ELEAZER
Suffix:
Gender:F
Credentials:MS, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 OLD US 70 W
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2547
Mailing Address - Country:US
Mailing Address - Phone:828-669-4161
Mailing Address - Fax:828-669-4164
Practice Address - Street 1:932 OLD US 70 W
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2547
Practice Address - Country:US
Practice Address - Phone:828-669-4161
Practice Address - Fax:828-669-4164
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20703101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)