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General NPI Number Information
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NPI Number | 1740659507
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Entity Type | Organization
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Legal Business Name | ELEV8TED PERSPECTIVES CONSULTATION SERVICES
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 606 JOHNSON AVE STE 17
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City | BOHEMIA
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State | NY
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Zip | 11716-2688
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Country | US
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Telephone | 631-800-1975
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Fax | 631-693-2798
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Provider Business Mailing Address
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Address Line | PO BOX 401
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City | MEDFORD
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State | NY
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Zip | 11763-0401
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Country | US
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Telephone | 631-800-1975
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Fax | 631-883-8511
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Authorized Official
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Title or Position | OWNER
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Name | LAQUETTA DASHEA SOLOMON
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Credential | LCSW
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Telephone | 631-800-1975
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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 | 076748-1
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License Number State | NY
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