Provider Demographics
NPI:1023788312
Name:ELEVATION COMMUNITY NETWORK LLC
Entity type:Organization
Organization Name:ELEVATION COMMUNITY NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-577-8330
Mailing Address - Street 1:2742 HARPER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8605
Mailing Address - Country:US
Mailing Address - Phone:678-577-8330
Mailing Address - Fax:
Practice Address - Street 1:6251 SMITHPOINTE DR STE 204
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2755
Practice Address - Country:US
Practice Address - Phone:678-577-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health