Provider Demographics
NPI:1205012705
Name:BLAIR, ELISE CHARLOTTE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:CHARLOTTE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5116 LOWELL LN NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2608
Mailing Address - Country:US
Mailing Address - Phone:202-331-1013
Mailing Address - Fax:202-364-3299
Practice Address - Street 1:5116 LOWELL LN NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2608
Practice Address - Country:US
Practice Address - Phone:202-331-1013
Practice Address - Fax:202-364-3299
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC300866104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker