Elite Psychotherapy and Behavioral Health Services, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904005723 Issued in VA

Legal business name

ELITE PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES, LLC

Practice address

612 Hull St Ste 101a
Richmond, VA 23224-4180

Phone

(804) 351-5971

Fax

(804) 351-5972

NPI assigned

Sep 25, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tina M. Fountain, LCSWNPI 1417944992

Title

Owner

Phone

(804) 677-0379

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tina M. Fountain, LCSW

  • Clinical Social Worker
  • Richmond, VA
  • NPI 1417944992
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1780133280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3209 OAKINGTON DR",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232317267",
            "telephone_number": "804-677-0379",
            "fax_number": "804-351-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 HULL ST STE 101A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232244180",
            "telephone_number": "804-351-5971",
            "fax_number": "804-351-5972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PSYCHOTHERAPY AND BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-25",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-677-0379",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904005723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Richmond, VA
• Providers in Richmond, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.