=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972203446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELON PSYCHOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2023
-----------------------------------------------------
Last Update Date | 03/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1157 HUFFMAN MILL RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-396-3406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1157 HUFFMAN MILL RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-396-3406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER; PSYCHOLOGIST
-----------------------------------------------------
Name | CAROLINE LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-797-3676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------