Provider Demographics
NPI:1578110805
Name:ELEVATION COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:ELEVATION COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIARRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LCAS
Authorized Official - Phone:336-908-9936
Mailing Address - Street 1:1922 S. MARTIN LUTHER KING JR. DR.
Mailing Address - Street 2:BOX 4
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107
Mailing Address - Country:US
Mailing Address - Phone:336-908-9936
Mailing Address - Fax:
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR STE 27
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-908-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558743542Medicaid