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General NPI Number Information
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NPI Number | 1558168633
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Entity Type | Organization
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Legal Business Name | ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 3900 PENN BELT PL STE B
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City | DISTRICT HEIGHTS
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State | MD
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Zip | 20747-4734
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Country | US
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Telephone | 301-276-5312
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Fax |
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Provider Business Mailing Address
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Address Line | 4305 TUCKERMAN ST
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City | UNIVERSITY PARK
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State | MD
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Zip | 20782-2146
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Country | US
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Telephone | 910-797-9218
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARRELL COLEMAN
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Credential |
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Telephone | 301-276-5312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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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