Provider Demographics
NPI:1366771461
Name:ELONZO DUNCAN INCORPORATED
Entity type:Organization
Organization Name:ELONZO DUNCAN INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN MSW
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:810-230-8617
Mailing Address - Street 1:3136 STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-3247
Mailing Address - Country:US
Mailing Address - Phone:810-239-8617
Mailing Address - Fax:810-230-8459
Practice Address - Street 1:G3500 FLUSHING RD
Practice Address - Street 2:SUITE 112E
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4235
Practice Address - Country:US
Practice Address - Phone:810-239-8617
Practice Address - Fax:810-230-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015593251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM00370Medicare PIN