Healthcare Provider Details

I. General information

NPI: 1154129674
Provider Name (Legal Business Name): ELITE STAIRS ,RAILS, & TRIMWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 US HIGHWAY 17 STE 103
FLEMING ISLAND FL
32003-4832
US

IV. Provider business mailing address

203 DOLPHIN CIR
MIDDLEBURG FL
32068-4717
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax: 904-269-0886
Mailing address:
  • Phone: 904-504-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA LANGFORD BAILES
Title or Position: OWNER
Credential: LMHC
Phone: 904-504-7370