Healthcare Provider Details

I. General information

NPI: 1346076486
Provider Name (Legal Business Name): ELIZABETH BALLANTYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SIKES PL STE 325
CHARLOTTE NC
28277-8208
US

IV. Provider business mailing address

515 JORDAN PL UNIT 575
CHARLOTTE NC
28205-3083
US

V. Phone/Fax

Practice location:
  • Phone: 704-247-7353
  • Fax:
Mailing address:
  • Phone: 240-315-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: