Healthcare Provider Details

I. General information

NPI: 1851471668
Provider Name (Legal Business Name): ELAINE KAY WESCOAT LPC, LSATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAFAYETTE BLVD SUITE 106
FREDERICKSBURG VA
22408-4271
US

IV. Provider business mailing address

4414 LAFAYETTE BLVD SUITE 106
FREDERICKSBURG VA
22408-4271
US

V. Phone/Fax

Practice location:
  • Phone: 540-847-2876
  • Fax: 540-371-4333
Mailing address:
  • Phone: 540-847-2876
  • Fax: 540-371-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0718000093
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003515
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: