Provider Demographics
NPI:1558168633
Name:ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-276-5312
Mailing Address - Street 1:4305 TUCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2146
Mailing Address - Country:US
Mailing Address - Phone:910-797-9218
Mailing Address - Fax:
Practice Address - Street 1:3900 PENN BELT PL STE B
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?:Yes
Parent Organization LBN:ELEVATION & ENRICHMENT THERAPEUTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty