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General NPI Number Information
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NPI Number | 1114403854
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Entity Type | Organization
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Legal Business Name | ELITE SERVICES, LLC
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 739 THIMBLE SHOALS BLVD STE 704
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3586
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Country | US
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Telephone | 757-223-1583
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Fax | 757-223-1502
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Provider Business Mailing Address
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Address Line | 739 THIMBLE SHOALS BLVD STE 704 BOX 9
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City | NEWPORT NEWS
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State | VA
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Zip | 23606
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Country | US
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Telephone | 757-223-1583
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Fax | 757-223-1502
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER
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Name | MRS. ASHLEY NICOLE MCCANTS
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Credential |
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Telephone | 757-223-1583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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