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NPI Code Detail

MEDICARE: ELIZABETH BALLANTYNE

MEDICARE: ELIZABETH BALLANTYNE
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1346076486
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BALLANTYNE
Provider Business Mailing Address
First Line : 515 JORDAN PL UNIT 575
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-3083
Country : US
Telephone Number : 240-315-8070
Fax Number :
Provider Business Practice Location Address
First Line : 10700 SIKES PL STE 325
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8208
Country : US
Telephone Number : 704-247-7353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2024
Last Update Date : 12/16/2025

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Directions to “ ELIZABETH BALLANTYNE ” Practice Location

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