Provider Demographics
NPI:1982277588
Name:ELLIOTT, ERIN LEIGH (MS, LCMHCA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 W ACADEMY ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3779
Mailing Address - Country:US
Mailing Address - Phone:919-603-4526
Mailing Address - Fax:
Practice Address - Street 1:942 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2582
Practice Address - Country:US
Practice Address - Phone:336-355-8697
Practice Address - Fax:336-546-7630
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316362551OtherFORSYTH FAMILY COUNSELING PLLC