Provider Demographics
NPI:1265016539
Name:ELEVATION THERAPY GROUP LLC
Entity Type:Organization
Organization Name:ELEVATION THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:IACARINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-845-0012
Mailing Address - Street 1:8940 OLD ANNAPOLIS RD STE E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2129
Mailing Address - Country:US
Mailing Address - Phone:443-845-0012
Mailing Address - Fax:
Practice Address - Street 1:1110 BENFIELD BLVD STE H
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2644
Practice Address - Country:US
Practice Address - Phone:443-845-0012
Practice Address - Fax:443-276-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)