Healthcare Provider Details

I. General information

NPI: 1417648601
Provider Name (Legal Business Name): ELEVATION ECOTHERAPY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MADISON ST. FL 3 STE 320B
ALEXANDRIA VA
22314-1764
US

IV. Provider business mailing address

701 MOUNTAIN VIEW RD
APPOMATTOX VA
24522-9856
US

V. Phone/Fax

Practice location:
  • Phone: 804-586-4278
  • Fax:
Mailing address:
  • Phone: 804-586-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN TEIGEN
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW, LCSW-C
Phone: 804-586-4278