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General NPI Number Information
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NPI Number | 1457133357
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Entity Type | Organization
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Legal Business Name | ELEVATELIFE THERAPY & CONSULTING, LICENSED CLINICAL SOCIAL WORKER, INC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 145 S FAIRFAX AVE STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90036-2186
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Country | US
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Telephone | 323-968-6404
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Fax | 213-315-4859
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Provider Business Mailing Address
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Address Line | 145 S FAIRFAX AVE STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90036-2186
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Country | US
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Telephone | 323-968-6404
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Fax | 213-315-4859
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Authorized Official
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Title or Position | OWNER
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Name | ANGELIQUE D YORK
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Credential | LCSW MSW
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Telephone | 323-968-6404
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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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