Provider Demographics
NPI:1386089159
Name:ELKINS, HEATHER (LMBT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ELKINS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 WILGROVE MINT HILL RD
Mailing Address - Street 2:STE B4
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3500
Mailing Address - Country:US
Mailing Address - Phone:704-839-1547
Mailing Address - Fax:704-545-8554
Practice Address - Street 1:4614 WILGROVE MINT HILL RD
Practice Address - Street 2:STE B4
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3500
Practice Address - Country:US
Practice Address - Phone:704-839-1547
Practice Address - Fax:704-545-8554
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist