Provider Demographics
NPI:1548090897
Name:ELEMENTAL EXPRESSIVE ARTS LLC
Entity type:Organization
Organization Name:ELEMENTAL EXPRESSIVE ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PENSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ATR-BC, EXAT
Authorized Official - Phone:757-524-1357
Mailing Address - Street 1:8227 OLD OCEAN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-2748
Mailing Address - Country:US
Mailing Address - Phone:757-434-2644
Mailing Address - Fax:
Practice Address - Street 1:1601 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:VA
Practice Address - Zip Code:24586-4417
Practice Address - Country:US
Practice Address - Phone:757-524-1357
Practice Address - Fax:757-296-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty