Provider Demographics
NPI:1255961504
Name:ELITE CONSULTANT SERVICES
Entity type:Organization
Organization Name:ELITE CONSULTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-977-3847
Mailing Address - Street 1:1200 ASHFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-2347
Mailing Address - Country:US
Mailing Address - Phone:704-977-3847
Mailing Address - Fax:888-564-4107
Practice Address - Street 1:454 ANDERSON RD S STE 162
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3398
Practice Address - Country:US
Practice Address - Phone:704-977-3847
Practice Address - Fax:888-564-4107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE CONSULTANT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health