Provider Demographics
NPI:1831665215
Name:RE-ELEVATION COUNSELING LLC
Entity Type:Organization
Organization Name:RE-ELEVATION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMSW
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTSIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-219-3711
Mailing Address - Street 1:872 S GROVE ST STE LL
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6300
Mailing Address - Country:US
Mailing Address - Phone:734-219-3711
Mailing Address - Fax:
Practice Address - Street 1:872 S GROVE ST STE LL
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6300
Practice Address - Country:US
Practice Address - Phone:734-219-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty