| Elite Psychotherapy And Behavioral Health Services, Llc | |
|
612 Hull St Ste 101a Richmond VA 23224-4180 | |
| (804) 351-5971 | |
| (804) 351-5972 |
| Full Name | Elite Psychotherapy And Behavioral Health Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 612 Hull St Ste 101a, 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 3209 Oakington Dr Richmond VA 23231-7267 Ph: (804) 677-0379 | Elite Psychotherapy And Behavioral Health Services, Llc 612 Hull St Ste 101a Richmond VA 23224-4180 Ph: (804) 351-5971 |
| NPI Number | 1780133280 |
|---|---|
| Provider Enumeration Date | 09/25/2016 |
| Last Update Date | 04/08/2025 |
| Certification Date | 04/08/2025 |
| 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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