Provider Demographics
NPI:1598429607
Name:ELDER, BOBBY V JR (LPCA)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:V
Last Name:ELDER
Suffix:JR
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RIPLEY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5121
Mailing Address - Country:US
Mailing Address - Phone:919-297-2393
Mailing Address - Fax:
Practice Address - Street 1:140 IOWA LN STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4495
Practice Address - Country:US
Practice Address - Phone:919-297-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health