Provider Demographics
NPI:1275269920
Name:ELDER, KERRON JR (LCAS-A, LCSW-A)
Entity Type:Individual
Prefix:
First Name:KERRON
Middle Name:
Last Name:ELDER
Suffix:JR
Gender:M
Credentials:LCAS-A, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 POPLARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1084
Mailing Address - Country:US
Mailing Address - Phone:919-787-6181
Mailing Address - Fax:
Practice Address - Street 1:2101 GARNER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-0114
Practice Address - Country:US
Practice Address - Phone:919-787-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28354101YA0400X
NCP0180081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)