Individual
JERRY TIMOTHY ELMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
3527A
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/08/2013
Last updated
11/08/2013
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