Provider Demographics
NPI:1982023586
Name:ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
Other - Org Name:ELEVATION & ENRICHMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-276-5312
Mailing Address - Street 1:3900 PENN BELT PL
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4734
Mailing Address - Country:US
Mailing Address - Phone:301-276-5312
Mailing Address - Fax:
Practice Address - Street 1:3900 PENN BELT PL
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-4734
Practice Address - Country:US
Practice Address - Phone:301-276-5312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MD19378251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty