Provider Demographics
NPI:1932136058
Name:ELIAS, KATHY ANN (LCMHC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ANN
Last Name:ELIAS
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 GLEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-6240
Mailing Address - Country:US
Mailing Address - Phone:919-779-3006
Mailing Address - Fax:919-329-5367
Practice Address - Street 1:283 GLEN RD STE B
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6240
Practice Address - Country:US
Practice Address - Phone:919-779-3006
Practice Address - Fax:919-329-5367
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3757101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14174OtherBLUE CROSS BLUE SHIELD
NC6102779Medicaid