Provider Demographics
| NPI: | 1225464225 |
|---|---|
| Name: | ELITE AAOLESCENT CARE, INC. |
| Entity Type: | Organization |
| Organization Name: | ELITE AAOLESCENT CARE, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | BARSHEEM |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHAPMAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 910-483-0324 |
| Mailing Address - Street 1: | 111 LAMON ST |
| Mailing Address - Street 2: | 103 |
| Mailing Address - City: | FAYETTEVILLE |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 28301-4901 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 910-483-0324 |
| Mailing Address - Fax: | 910-483-2246 |
| Practice Address - Street 1: | 20513 S HIGHWAY 301 NORTH |
| Practice Address - Street 2: | |
| Practice Address - City: | ST. PAULS |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 28384 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 910-483-0234 |
| Practice Address - Fax: | 910-483-2246 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2013-09-23 |
| Last Update Date: | 2013-09-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NC | 6008828 | Medicaid |
