Healthcare Provider Details

I. General information

NPI: 1629825658
Provider Name (Legal Business Name): ELEVATE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 BREMO RD STE 202
RICHMOND VA
23226-2441
US

IV. Provider business mailing address

2002 BREMO RD STE 202
RICHMOND VA
23226-2441
US

V. Phone/Fax

Practice location:
  • Phone: 773-919-9351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK WELDLER
Title or Position: MANAGER
Credential:
Phone: 773-919-9351