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NPI Code Detail

MEDICARE: MS. ELIZABETH S BLALOCK MSW, LCSW

MEDICARE: MS. ELIZABETH S BLALOCK MSW, LCSW
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 WorkerC003552NC

General Provider Information

NPI Number : 1982641114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH S BLALOCK MSW, LCSW
Provider Business Mailing Address
First Line : 6809 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3336
Country : US
Telephone Number : 704-365-7777
Fax Number : 704-554-9682
Provider Business Practice Location Address
First Line : 6809 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3336
Country : US
Telephone Number : 704-365-7777
Fax Number : 704-554-9682
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 07/08/2007

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