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General NPI Number Information
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NPI Number | 1255961504
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Entity Type | Organization
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Legal Business Name | ELITE CONSULTANT SERVICES
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 454 ANDERSON RD S STE 162
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City | ROCK HILL
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State | SC
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Zip | 29730-3398
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Country | US
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Telephone | 704-977-3847
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Fax | 888-564-4107
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Provider Business Mailing Address
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Address Line | 1200 ASHFORD ST
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City | CHARLOTTE
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State | NC
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Zip | 28214-2347
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Country | US
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Telephone | 704-977-3847
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Fax | 888-564-4107
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | LORI LONG
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Credential |
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Telephone | 704-977-3847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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