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General NPI Number Information
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NPI Number | 1265016539
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Entity Type | Organization
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Legal Business Name | ELEVATION THERAPY GROUP LLC
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 1110 BENFIELD BLVD STE H
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City | MILLERSVILLE
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State | MD
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Zip | 21108-2644
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Country | US
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Telephone | 443-845-0012
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Fax | 443-276-2800
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Provider Business Mailing Address
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Address Line | 8940 OLD ANNAPOLIS RD STE E
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City | COLUMBIA
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State | MD
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Zip | 21045-2129
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Country | US
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Telephone | 443-845-0012
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ADAM L IACARINO
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Credential | LCPC
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Telephone | 443-845-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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