Provider Demographics
NPI:1306244223
Name:ELDER, MARY JEAN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:ELDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N LAFAYETTE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3886
Mailing Address - Country:US
Mailing Address - Phone:704-995-7075
Mailing Address - Fax:
Practice Address - Street 1:809 N LAFAYETTE ST STE A
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-284-0554
Practice Address - Fax:704-448-2003
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11232101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional