Provider Demographics
NPI:1376932517
Name:CONSTANT ELEVATION, LLC
Entity Type:Organization
Organization Name:CONSTANT ELEVATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMARCO
Authorized Official - Middle Name:FELICIANO
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-437-4117
Mailing Address - Street 1:421 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5016
Mailing Address - Country:US
Mailing Address - Phone:336-437-4117
Mailing Address - Fax:
Practice Address - Street 1:421 W 26TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5016
Practice Address - Country:US
Practice Address - Phone:336-437-4117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty