Provider Demographics
NPI:1619685260
Name:ELROD, ANGELIC LERAY EVANS (LMBT)
Entity Type:Individual
Prefix:MS
First Name:ANGELIC
Middle Name:LERAY EVANS
Last Name:ELROD
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 FULCHER LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-6560
Mailing Address - Country:US
Mailing Address - Phone:910-358-4027
Mailing Address - Fax:
Practice Address - Street 1:302 FULCHER LANDING RD
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-6560
Practice Address - Country:US
Practice Address - Phone:910-358-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist