Organization
ELEVATE YOUTH SERVICES INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FAVOR ELLIS MA (EXECUTIVE DIRECTOR)
(802) 229-9151
Entity
Organization
Contact information
Practice address
652 GRANGER RD, BARRE, VT 05641-5363
(802) 229-9151
(802) 229-2508
Mailing address
652 GRANGER RD, BARRE, VT 05641-5363
(802) 229-9151
(802) 229-2508
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000350
VT
103T00000X
Psychologist
0470000720
VT
1041C0700X
Clinical Social Worker
0890000651
VT
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004380
—
VT
05
—
1010291
—
VT
05
—
1010292
—
VT
Enumeration date
11/09/2006
Last updated
11/26/2024
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