Individual
DR. MARY JANE ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3779 VEST MILL RD, SUITE B, WINSTON SALEM, NC 27103-2991
(336) 768-0919
(336) 740-9135
Mailing address
3779 VEST MILL RD, SUITE B, WINSTON SALEM, NC 27103-2991
(336) 768-0919
(336) 740-9135
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
18853
CA
103TC0700X
Clinical Psychologist
Primary
3939
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6001212
—
NC
Enumeration date
05/01/2007
Last updated
08/17/2010
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