Healthcare Provider Details

I. General information

NPI: 1609119981
Provider Name (Legal Business Name): VONDA ELLIOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VONDA F COVINGTON LCSW

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 S BRAGG BLVD
SPRING LAKE NC
28390-3929
US

IV. Provider business mailing address

159 S CHURCHILL DR
FAYETTEVILLE NC
28303-5006
US

V. Phone/Fax

Practice location:
  • Phone: 910-916-7881
  • Fax:
Mailing address:
  • Phone: 404-576-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008635
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: