MEDICARE: ELENA MARIE EDDINGTON LCSW-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P021224	NC

General Provider Information

NPI Number	:	1861225633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA MARIE EDDINGTON LCSW-A

Provider Business Mailing Address
First Line	:	820 DEMERIUS ST APT P2
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-1669
Country	:	US
Telephone Number	:	225-620-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 CREEDMOOR RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1710
Country	:	US
Telephone Number	:	919-912-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	09/03/2024

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