Organization
ELEMENTAL HEALTH CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAVAH ISABEL HENZLER LCSW, LCAS (OWNER)
(910) 599-4017
Entity
Organization
Contact information
Practice address
5030 RANDALL PKWY, WILMINGTON, NC 28403-2829
(910) 240-4757
Mailing address
5030 RANDALL PKWY, WILMINGTON, NC 28403-2829
(910) 240-4757
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1000X
Migrant Health Clinic/Center
—
—
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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