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General NPI Number Information
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NPI Number | 1770387045
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Entity Type | Individual
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Provider Name | ELIE ANTOINE CHALLITA MA, LCMHCA, LCAS-A
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Gender | Male
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 2005 FLINT LN
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City | GASTONIA
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State | NC
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Zip | 28054-3334
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Country | US
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Telephone | 980-522-8247
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Fax |
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Provider Business Mailing Address
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Address Line | 107 ANN ST
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-9220
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Country | US
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Telephone | 704-308-7465
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 30621
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10337
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A21253
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License Number State | NC
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