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
2	101Y00000X	Counselor	8809-226	WI

General Provider Information

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

Provider Business Mailing Address
First Line	:	132 ACRES CT
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2539
Country	:	US
Telephone Number	:	434-262-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 ACRES CT
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2539
Country	:	US
Telephone Number	:	434-262-0165
Fax Number	:

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

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	05/26/2026

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Directions to “ LAURA WILCOXEN ” Practice Location

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