Provider Demographics
NPI:1306725478
Name:ELEVATED INTIMACY, INC., LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:ELEVATED INTIMACY, INC., LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW-S, CST
Authorized Official - Phone:805-666-1022
Mailing Address - Street 1:1117 STATE ST # 1001
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2712
Mailing Address - Country:US
Mailing Address - Phone:805-666-1022
Mailing Address - Fax:805-254-0441
Practice Address - Street 1:610 E CANON PERDIDO ST APT 9
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3037
Practice Address - Country:US
Practice Address - Phone:805-666-1022
Practice Address - Fax:805-254-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty