MEDICARE: ELITE ADOLESCENT CARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YS0200X	School Counselor
5	103T00000X	Psychologist
6	103TA0400X	Addiction (Substance Use Disorder) Psychologist
7	103TB0200X	Cognitive & Behavioral Psychologist
8	103TC0700X	Clinical Psychologist
9	103TC1900X	Counseling Psychologist
10	103TC2200X	Clinical Child & Adolescent Psychologist
11	103TP0016X	Prescribing (Medical) Psychologist
12	1041C0700X	Clinical Social Worker
13	1041S0200X	School Social Worker
14	106H00000X	Marriage & Family Therapist
15	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689000689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE ADOLESCENT CARE, INC.

Provider Business Mailing Address
First Line	:	111 LAMON ST
Second Line	:	SUITE 103
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-4901
Country	:	US
Telephone Number	:	910-483-0324
Fax Number	:	910-483-2246

Provider Business Practice Location Address
First Line	:	4501 OLD BATTLEGROUND RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-9352
Country	:	US
Telephone Number	:	910-483-0324
Fax Number	:	910-483-2246

Authorized Official
Title or Position	:	CEO
Name	:	MR. BARSHEEM CHAPMAN
Credential	:
Telephone Number	:	910-483-0324

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	09/23/2013

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