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General NPI Number Information
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NPI Number | 1548090897
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Entity Type | Organization
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Legal Business Name | ELEMENTAL EXPRESSIVE ARTS LLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1601 COUNTRYSIDE DR
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City | RINGGOLD
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State | VA
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Zip | 24586-4417
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Country | US
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Telephone | 757-524-1357
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Fax | 757-296-0837
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Provider Business Mailing Address
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Address Line | 8227 OLD OCEAN VIEW RD
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City | NORFOLK
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State | VA
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Zip | 23518-2748
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Country | US
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Telephone | 757-434-2644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH D PENSTON
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Credential | LPC, ATR-BC, EXAT
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Telephone | 757-524-1357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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