Provider Demographics
NPI:1992906127
Name:ELAM, CARRIE DARROCH (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:DARROCH
Last Name:ELAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 HEATHSTEAD PL APT I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7104
Mailing Address - Country:US
Mailing Address - Phone:704-604-4189
Mailing Address - Fax:
Practice Address - Street 1:2017 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5313
Practice Address - Country:US
Practice Address - Phone:704-609-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist