Healthcare Provider Details

I. General information

NPI: 1326964669
Provider Name (Legal Business Name): ELEVATE YOUTH MENTORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 COUNTRY CLUB DR NE
CONCORD NC
28025-0915
US

IV. Provider business mailing address

1914 J N PEASE PL # 1020
CHARLOTTE NC
28262-4504
US

V. Phone/Fax

Practice location:
  • Phone: 301-532-3917
  • Fax:
Mailing address:
  • Phone: 301-532-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BILLY D WILLIAMS
Title or Position: CEO
Credential:
Phone: 301-532-3917