| Elite Psychotherapy And Behavioral Health Services, Llc | |
|
1405 Westover Hills Blvd Suite #2 Richmond VA 23225-3153 | |
| (804) 677-0379 | |
| Not Available |
| Full Name | Elite Psychotherapy And Behavioral Health Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1405 Westover Hills Blvd, Richmond, Virginia |
| Authorized Official Name and Position | Tina Marie Fountain (OWNER/CEO) |
| Authorized Official Contact | 8046770379 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Psychotherapy And Behavioral Health Services, Llc 1405 Westover Hills Blvd Suite #2 Richmond VA 23225-3153 Ph: (804) 677-0379 | Elite Psychotherapy And Behavioral Health Services, Llc 1405 Westover Hills Blvd Suite #2 Richmond VA 23225-3153 Ph: (804) 677-0379 |
| NPI Number | 1780133280 |
|---|---|
| Provider Enumeration Date | 09/25/2016 |
| Last Update Date | 09/25/2016 |
| Medicare PECOS PAC ID | 2769763044 |
|---|---|
| Medicare Enrollment ID | O20161228000733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780133280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0904005723 (Virginia) | Primary |
| Provider Name | Tina M Fountain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417944992 PECOS PAC ID: 2668407495 Enrollment ID: I20050930000076 |
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