Provider Demographics
NPI:1780133280
Name:ELITE PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ELITE PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-677-0379
Mailing Address - Street 1:3209 OAKINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-7267
Mailing Address - Country:US
Mailing Address - Phone:804-677-0379
Mailing Address - Fax:804-351-5972
Practice Address - Street 1:612 HULL ST STE 101A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4180
Practice Address - Country:US
Practice Address - Phone:804-351-5971
Practice Address - Fax:804-351-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty