Provider Demographics
NPI:1275764789
Name:WEBB, ELAINE W (MSW,LCSW,CEAP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:W
Last Name:WEBB
Suffix:
Gender:F
Credentials:MSW,LCSW,CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5599
Mailing Address - Country:US
Mailing Address - Phone:704-664-1009
Mailing Address - Fax:704-664-1029
Practice Address - Street 1:134 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5599
Practice Address - Country:US
Practice Address - Phone:704-664-1009
Practice Address - Fax:704-664-1029
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical