Healthcare Provider Details

I. General information

NPI: 1649626656
Provider Name (Legal Business Name): PROFESSIONAL ELEVATIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 CRUTCHFIELD DRIVE
DURHAM NC
27704
US

IV. Provider business mailing address

1058 W CLUB BLVD STE 602
DURHAM NC
27701-1104
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-4831
  • Fax: 919-797-1960
Mailing address:
  • Phone: 919-638-4831
  • Fax: 919-797-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007209
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. HILDA LAVETTE WILLIAMS
Title or Position: OWNER
Credential: LCSW
Phone: 919-638-4831