Healthcare Provider Details

I. General information

NPI: 1780408666
Provider Name (Legal Business Name): ELIJAH NATHANIEL HELM BSW, MSW, LCSW(A)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 HIGHWAY 55 E
CLOVER SC
29710-9142
US

IV. Provider business mailing address

1963 HIGHWAY 55 E
CLOVER SC
29710-9142
US

V. Phone/Fax

Practice location:
  • Phone: 803-221-2087
  • Fax:
Mailing address:
  • Phone: 803-221-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021497
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: