Provider Demographics
NPI:1316728926
Name:KELLOGG, ELIZABETH A (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 ALLOY ST UNIT 218
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-7478
Mailing Address - Country:US
Mailing Address - Phone:574-250-5053
Mailing Address - Fax:
Practice Address - Street 1:9205 BAILEYWICK RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1977
Practice Address - Country:US
Practice Address - Phone:919-845-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0197241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical