Healthcare Provider Details

I. General information

NPI: 1831706373
Provider Name (Legal Business Name): ELENA PLOCEK LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA PLOCEK LCSWA

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 FARTHING ST
DURHAM NC
27704-4203
US

IV. Provider business mailing address

2617 FARTHING ST
DURHAM NC
27704-4203
US

V. Phone/Fax

Practice location:
  • Phone: 352-727-1044
  • Fax:
Mailing address:
  • Phone: 352-727-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014757
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: