National Provider Identifier Database

ELEMENTAL HEALTH CLINIC PLLC
Mental Health (Including Community Mental Health Center)

Contact Information

ELEMENTAL HEALTH CLINIC PLLC
5030 RANDALL PKWY
WILMINGTON, NC  28403-2829
Phone: 910-240-4757
Fax:
Website:
Specialty Taxonomy Code
* Mental Health (Including Community Mental Health Center) 261QM0801X
Adolescent and Children Mental Health 261QM0855X
Adult Mental Health 261QM0850X
Migrant Health 261QM1000X
Military/U.S. Coast Guard Outpatient 261QM1100X
Multi-Specialty 261QM1300X
Physical Therapy 261QP2000X
Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for ELEMENTAL HEALTH CLINIC PLLC

NPI Number 1558015305
Legal business name
LBN		 ELEMENTAL HEALTH CLINIC PLLC
Authorized official HAVAH HENZLER - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 02/10/2022
Last updated 02/10/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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