Healthcare Provider Details

I. General information

NPI: 1043132194
Provider Name (Legal Business Name): ELEVATE AND RENEW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TECH CENTER PKWY STE 200-142
NEWPORT NEWS VA
23606-3075
US

IV. Provider business mailing address

700 TECH CENTER PKWY STE 200-142
NEWPORT NEWS VA
23606-3075
US

V. Phone/Fax

Practice location:
  • Phone: 804-300-6500
  • Fax:
Mailing address:
  • Phone: 804-300-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDRA TYLER
Title or Position: OWNER
Credential:
Phone: 804-300-6500