Provider Demographics
NPI:1609886076
Name:ELLIOTT, GEORGE HENRY (LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HENRY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 MOUNTAIN HOME DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5761
Mailing Address - Country:US
Mailing Address - Phone:910-826-6795
Mailing Address - Fax:910-875-0072
Practice Address - Street 1:132 W ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2802
Practice Address - Country:US
Practice Address - Phone:910-875-0070
Practice Address - Fax:910-875-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140P9OtherBLUECROSS BLUESHIELD LPC
NC6102023Medicaid