MEDICARE: ELEVATE LEADERSHIP 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1639526544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE LEADERSHIP LLC

Provider Business Mailing Address
First Line	:	124 LUTHER RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1804
Country	:	US
Telephone Number	:	919-703-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 LUTHER RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1804
Country	:	US
Telephone Number	:	919-703-0800
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MELONIE MARSH
Credential	:
Telephone Number	:	919-703-0800

Provider Enumeration Date	:	05/20/2016
Last Update Date	:	05/20/2016

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Directions to “ELEVATE LEADERSHIP LLC ” Practice Location

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