MEDICARE: MR. ELBERT CHARLES OWENS LPC

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
1	101YM0800X	Mental Health Counselor	4601	NC
2	101YP2500X	Professional Counselor	4601	NC

General Provider Information

NPI Number	:	1609822832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELBERT CHARLES OWENS LPC

Provider Business Mailing Address
First Line	:	824 GUM BRANCH RD STE B
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6269
Country	:	US
Telephone Number	:	910-353-8255
Fax Number	:	910-355-2427

Provider Business Practice Location Address
First Line	:	824 GUM BRANCH RD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6269
Country	:	US
Telephone Number	:	910-353-8255
Fax Number	:	910-355-2427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	12/04/2017

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