Healthcare Provider Details

I. General information

NPI: 1306725478
Provider Name (Legal Business Name): ELEVATED INTIMACY, INC., LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PENINSULA RD APT 131
OXNARD CA
93035-4042
US

IV. Provider business mailing address

1000 TOWN CENTER DR STE 300 #1060
OXNARD CA
93036-1117
US

V. Phone/Fax

Practice location:
  • Phone: 805-666-1022
  • Fax: 805-254-0441
Mailing address:
  • Phone: 805-666-1022
  • Fax: 805-254-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTINE MEADOR
Title or Position: CEO
Credential: PHD, LCSW-S, CST
Phone: 805-666-1022