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NPI Code Detail

MEDICARE: ELBISA LINDOV MA,LCMHC

MEDICARE: ELBISA LINDOV MA,LCMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor17239NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
117239OTHERNCLCMHC

General Provider Information

NPI Number : 1093466153
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELBISA LINDOV MA,LCMHC
Provider Business Mailing Address
First Line : 1612 COVINGTON HEIGHTS CIR
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-2081
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1205 S MAIN ST
Second Line :
City : BURLINGTON
State : NC
Zip : 27215-5762
Country : US
Telephone Number : 336-684-9951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2022
Last Update Date : 02/03/2026

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