Healthcare Provider Details

I. General information

NPI: 1528970019
Provider Name (Legal Business Name): JONATHAN WADE MCELDERRY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 WINDSOR AVE
COLONIAL HEIGHTS VA
23834-3247
US

IV. Provider business mailing address

141 WINDSOR AVE
COLONIAL HEIGHTS VA
23834-3247
US

V. Phone/Fax

Practice location:
  • Phone: 804-807-5254
  • Fax: 804-732-1433
Mailing address:
  • Phone: 804-807-5254
  • Fax: 804-732-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: