Basic Information
| Provider Information | |||||||||
| NPI: | 1275269920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELDER | ||||||||
| FirstName: | KERRON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LCAS-A, LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 POPLARWOOD CT | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276041084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197876181 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2101 GARNER RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276100114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197876131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2022 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P018008 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.