Provider Demographics
NPI:1518024173
Name:DUNCAN, ELONZO (MSW)
Entity Type:Individual
Prefix:
First Name:ELONZO
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:M
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:G3500 FLUSHING RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4235
Mailing Address - Country:US
Mailing Address - Phone:810-230-8617
Mailing Address - Fax:810-230-8459
Practice Address - Street 1:G3500 FLUSHING RD
Practice Address - Street 2:SUITE 112
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4235
Practice Address - Country:US
Practice Address - Phone:810-230-8617
Practice Address - Fax:810-230-8459
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW6801015593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0894550OtherBLUE CROSS BLUE SHIELD
MI046678OtherVALUEOPTIONS
MI046678OtherBLUE CARE NETWORK OF MICH
MI202062000OtherMAGELLAN BEHAVIORAL HEALT
MI0M00370OtherMEDICARE
TX0007290046OtherAENTA