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General NPI Number Information
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NPI Number | 1417648601
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Entity Type | Organization
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Legal Business Name | ELEVATION ECOTHERAPY PLC
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 209 MADISON ST. FL 3 STE 320B
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1764
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Country | US
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Telephone | 804-586-4278
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Fax |
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Provider Business Mailing Address
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Address Line | 701 MOUNTAIN VIEW RD
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City | APPOMATTOX
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State | VA
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Zip | 24522-9856
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Country | US
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Telephone | 804-586-4278
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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 | ERIN TEIGEN
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Credential | MSW, LCSW, LCSW-C
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Telephone | 804-586-4278
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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