Provider Demographics
NPI:1831887058
Name:ELEVATE SPORT PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:ELEVATE SPORT PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-615-3512
Mailing Address - Street 1:7313 CATESWOOD CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9387
Mailing Address - Country:US
Mailing Address - Phone:973-615-3512
Mailing Address - Fax:
Practice Address - Street 1:7313 CATESWOOD CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-9387
Practice Address - Country:US
Practice Address - Phone:973-615-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty