Provider Demographics
NPI:1881724763
Name:ELBERT C OWENS LPC PC
Entity type:Organization
Organization Name:ELBERT C OWENS LPC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:910-353-8255
Mailing Address - Street 1:412 SHARON WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5926
Mailing Address - Country:US
Mailing Address - Phone:910-353-8255
Mailing Address - Fax:910-355-2427
Practice Address - Street 1:824 GUM BRANCH RD STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6269
Practice Address - Country:US
Practice Address - Phone:910-353-8255
Practice Address - Fax:910-355-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102028Medicaid