Healthcare Provider Details

I. General information

NPI: 1275414211
Provider Name (Legal Business Name): AVA-CHRISTINE ANDERSON ELDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18A PARKWAY COMMONS WAY
GREER SC
29650-5213
US

IV. Provider business mailing address

2117 CLEVELAND STREET EXT
GREENVILLE SC
29607-3649
US

V. Phone/Fax

Practice location:
  • Phone: 229-938-9552
  • Fax:
Mailing address:
  • Phone: 229-938-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSC

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: