Provider Demographics
NPI:1467756130
Name:ELTON, NICOLE CARPENTER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CARPENTER
Last Name:ELTON
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 1:360 CAMPBELL AVE, SW
Mailing Address - Street 2:FAMILY SERVICE OF ROANOKE VALLEY,
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016
Mailing Address - Country:US
Mailing Address - Phone:540-563-5316
Mailing Address - Fax:
Practice Address - Street 1:360 CAMPBELL AVE, SW
Practice Address - Street 2:FAMILY SERVICE OF ROANOKE VALLEY
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-563-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040075401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical