Healthcare Provider Details

I. General information

NPI: 1831887058
Provider Name (Legal Business Name): ELEVATE SPORT PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7313 CATESWOOD CT
APEX NC
27539-9387
US

IV. Provider business mailing address

7313 CATESWOOD CT
APEX NC
27539-9387
US

V. Phone/Fax

Practice location:
  • Phone: 973-615-3512
  • Fax:
Mailing address:
  • Phone: 973-615-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LONNIE SARNELL
Title or Position: OWNER/PSYCHOLOGIST
Credential:
Phone: 973-615-3512