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General NPI Number Information
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NPI Number | 1164983128
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Entity Type | Organization
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Legal Business Name | ELEVATE TREATMENT SERVICES, LLC
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Dates
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Enumeration Date | 03/30/2019
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Last Update Date | 03/30/2019
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Provider Practice Location Address
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Address Line | 1000 HIGHLAND COLONY PKWY STE 5203
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City | RIDGELAND
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State | MS
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Zip | 39157-2079
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Country | US
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Telephone | 601-502-3629
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1087
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City | MADISON
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State | MS
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Zip | 39130-1087
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Country | US
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Telephone | 601-502-3629
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. LEO WILLIAMS III
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Credential | LCSW
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Telephone | 601-502-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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