Healthcare Provider Details

I. General information

NPI: 1467315440
Provider Name (Legal Business Name): ELISHA M. WATTS HEVERLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISHA M HEVERLY LCSW

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 HIGHWOODS BLVD
RALEIGH NC
27604-1064
US

IV. Provider business mailing address

1646 N ATHERTON ST # 1092
STATE COLLEGE PA
16803-1416
US

V. Phone/Fax

Practice location:
  • Phone: 919-834-6506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027638
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: