Individual
MRS. CHARLOTTE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6334 CONSTITUTION DR, FORT WAYNE, IN 46804-1518
(260) 209-1209
(260) 782-3215
Mailing address
6334 CONSTITUTION DR STE 23, FORT WAYNE, IN 46804-1518
(260) 209-1209
(260) 782-3215
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
34004693A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200026750A
—
IN
Enumeration date
12/07/2006
Last updated
03/15/2019
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