Healthcare Provider Details

I. General information

NPI: 1740110998
Provider Name (Legal Business Name): ELEVARE IN GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CUMBERLAND PKWY. SE SUITE 410 PMB 1037
ATLANTA GA
30339
US

IV. Provider business mailing address

2700 CUMBERLAND PKWY. SE SUITE 410 PMB 1037
ATLANTA GA
30339
US

V. Phone/Fax

Practice location:
  • Phone: 317-563-1117
  • Fax: 317-608-3436
Mailing address:
  • Phone: 317-563-1117
  • Fax: 317-608-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANTEL WHITE
Title or Position: CO-OWNER
Credential: LCSW
Phone: 317-563-1117