MEDICARE: LAURA WILCOXEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0704016373	VA

General Provider Information

NPI Number	:	1235955535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WILCOXEN

Provider Business Mailing Address
First Line	:	15421 FOREST RD STE C
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2274
Country	:	US
Telephone Number	:	434-262-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	15421 FOREST RD STE C
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2274
Country	:	US
Telephone Number	:	434-338-7129
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	08/08/2025

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Directions to “ LAURA WILCOXEN ” Practice Location

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