Provider Demographics
NPI:1891109740
Name:ELMORE, KENZIE DELRAE (LCSW)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:DELRAE
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:
Practice Address - Street 1:600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-1146
Practice Address - Country:US
Practice Address - Phone:828-428-8197
Practice Address - Fax:828-428-8341
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0088111041C0700X
NCC0103151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical