Provider Demographics
NPI:1639857048
Name:ELDER, SYDNEY LOUISE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LOUISE
Last Name:ELDER
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 W 1ST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3642
Mailing Address - Country:US
Mailing Address - Phone:336-914-3038
Mailing Address - Fax:
Practice Address - Street 1:1022 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3642
Practice Address - Country:US
Practice Address - Phone:336-914-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health