Organization
EDH1 LLC
Active
Organization
EDH1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELSTON DERREK HOOPER (OWNER)
(980) 297-0703
Entity
Organization
Contact information
Practice address
9027 TIBBLE CREEK WAY, CHARLOTTE, NC 28227-6670
(980) 297-0703
Mailing address
9027 TIBBLE CREEK WAY, CHARLOTTE, NC 28227-6670
(980) 297-0703
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TH0100X
Health Service Psychologist
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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