Healthcare Provider Details

I. General information

NPI: 1952651267
Provider Name (Legal Business Name): ELISHA AGEE PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX 800223
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST. BOX 800223
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5314
  • Fax: 434-243-4743
Mailing address:
  • Phone: 434-924-5314
  • Fax: 434-243-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: