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General NPI Number Information
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NPI Number | 1659092625
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Entity Type | Organization
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Legal Business Name | ELEVATED SOUL THERAPY LLC
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1806 SUMMIT AVE STE 300
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City | RICHMOND
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State | VA
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Zip | 23230-4339
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Country | US
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Telephone | 804-420-9449
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Fax | 804-885-2582
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Provider Business Mailing Address
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Address Line | 1806 SUMMIT AVE STE 300
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City | RICHMOND
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State | VA
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Zip | 23230-4339
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Country | US
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Telephone | 804-420-9449
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Fax | 804-885-2582
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MELODI HICKEY
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Credential | LCSW, CAM
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Telephone | 815-210-0833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 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 #3
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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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Taxonomy #4
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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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