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General NPI Number Information
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NPI Number | 1659267029
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Entity Type | Individual
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Provider Name | ELANA BLAKE LCSWA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 3901 THOMPSON ST
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City | CHARLOTTE
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State | NC
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Zip | 28216-3941
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Country | US
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Telephone | 980-819-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 1322 HILL ST
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City | ALBEMARLE
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State | NC
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Zip | 28001-9612
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Country | US
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Telephone | 980-267-5624
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P019662
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License Number State | NC
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