MEDICARE: ELEVATING GROWTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1104704592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATING GROWTH, LLC

Provider Business Mailing Address
First Line	:	12955 BISCAYNE BLVD STE 200
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 SW 28TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2917
Country	:	US
Telephone Number	:	954-638-6032
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NATHALY DORVIL
Credential	:
Telephone Number	:	954-638-6032

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	09/01/2025

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Directions to “ELEVATING GROWTH, LLC ” Practice Location

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