Healthcare Provider Details

I. General information

NPI: 1275308074
Provider Name (Legal Business Name): EMILY NICHOLE WINGFIELD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 CROSSINGS CENTER DR STE A
FOREST VA
24551-5081
US

IV. Provider business mailing address

1443 CROSSINGS CENTER DR STE A
FOREST VA
24551-5081
US

V. Phone/Fax

Practice location:
  • Phone: 434-219-5621
  • Fax:
Mailing address:
  • Phone: 434-219-5621
  • Fax: 434-305-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011845
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: