Healthcare Provider Details

I. General information

NPI: 1396496634
Provider Name (Legal Business Name): ELIZABETH PALMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 RAINTREE RD STE A
CHESAPEAKE VA
23321-3749
US

IV. Provider business mailing address

2324 ALDER ST
NORFOLK VA
23513-4302
US

V. Phone/Fax

Practice location:
  • Phone: 757-606-1377
  • Fax: 757-951-1286
Mailing address:
  • Phone: 703-638-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011161
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: