Healthcare Provider Details

I. General information

NPI: 1356105449
Provider Name (Legal Business Name): ELIZABETH ELLIS SCHUBERT PH.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 RAINES CREEK LN
BOHANNON VA
23021-2002
US

IV. Provider business mailing address

PO BOX 611
NORTH VA
23128-0611
US

V. Phone/Fax

Practice location:
  • Phone: 804-201-3604
  • Fax:
Mailing address:
  • Phone: 804-201-3604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: