Elite Therapeutic Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ELITE THERAPEUTIC SERVICES, LLC

Doing business as

Mary's Manger

Practice address

2401 Crepe Myrtle LN
Chesapeake, VA 23325-4644

Phone

(757) 735-4565

NPI assigned

Aug 24, 2013

Last updated

Aug 24, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly M Haywood

Title

Owner

Phone

(757) 735-4565

Specialties & licenses 1

Addresses

Other names 1

• Mary's Manger Doing business as

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

{
    "created_epoch": "1377302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377302400000",
    "number": "1942634126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 CREPE MYRTLE LN",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233254644",
            "telephone_number": "757-735-4565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 CREPE MYRTLE LN",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233254644",
            "telephone_number": "757-735-4565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE THERAPEUTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-24",
        "last_updated": "2013-08-24",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-735-4565",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary's Manger",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Mental Health Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.