Healthcare Provider Details

I. General information

NPI: 1760971493
Provider Name (Legal Business Name): HOLISTIC ELEVATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LANCASTER PIKE STE 305
WILMINGTON DE
19805-1511
US

IV. Provider business mailing address

2220 PORTER RD
BEAR DE
19701-2022
US

V. Phone/Fax

Practice location:
  • Phone: 302-278-0026
  • Fax: 302-278-0047
Mailing address:
  • Phone: 318-533-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICE MURIEL STEVENS
Title or Position: FOUNDER/CEO
Credential: LPCMH
Phone: 302-278-0026