Individual
DR. STEPHEN SEALS ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3205 RANDALL PKWY STE 105, WILMINGTON, NC 28403-2565
(910) 742-9243
(888) 746-1787
Mailing address
PO BOX 538622, ATLANTA, GA 30353-8622
(910) 742-9243
(888) 746-1787
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
1010
NC
103TC2200X
Clinical Child & Adolescent Psychologist
1010
NC
106H00000X
Marriage & Family Therapist
283
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000042
—
NC
01
—
P01126726
RR MEDICARE
NC
Enumeration date
01/17/2007
Last updated
01/30/2019
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