Provider Demographics
NPI:1053166579
Name:ELEVATING MINDS WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:ELEVATING MINDS WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-360-2400
Mailing Address - Street 1:10204 EYELET CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5832
Mailing Address - Country:US
Mailing Address - Phone:202-360-2400
Mailing Address - Fax:
Practice Address - Street 1:80 M ST SE STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3550
Practice Address - Country:US
Practice Address - Phone:202-360-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty