Provider Demographics
NPI:1578847836
Name:DURONVILLE, ELSIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:
Last Name:DURONVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ELSIE
Other - Middle Name:
Other - Last Name:ROMILUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:1819 CAPSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5847
Mailing Address - Country:US
Mailing Address - Phone:919-282-2989
Mailing Address - Fax:
Practice Address - Street 1:1819 CAPSTONE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5847
Practice Address - Country:US
Practice Address - Phone:919-282-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0108361041C0700X
NYCO10836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical