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General NPI Number Information
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NPI Number | 1467315440
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Entity Type | Individual
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Provider Name | ELISHA M. WATTS HEVERLY
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2912 HIGHWOODS BLVD
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City | RALEIGH
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State | NC
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Zip | 27604-1064
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Country | US
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Telephone | 919-834-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 N ATHERTON ST # 1092
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City | STATE COLLEGE
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State | PA
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Zip | 16803-1416
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW140232
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License Number State | PA
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