Individual
JERRY TIMOTHY ELMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
2505 COURT DR, GASTONIA, NC 28054-2140
(704) 884-2060
(704) 854-4860
Mailing address
631 BRAWLEY SCHOOL RD, STE 200B PMB 301, MOORESVILLE, NC 28117-6208
(704) 884-2060
(704) 854-4860
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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