Healthcare Provider Details

I. General information

NPI: 1588577175
Provider Name (Legal Business Name): ELAINE WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 INNSLAKE DR STE 300
GLEN ALLEN VA
23060-3327
US

IV. Provider business mailing address

4201 COLLECTIVE CIR
RICHMOND VA
23238-6436
US

V. Phone/Fax

Practice location:
  • Phone: 804-585-2347
  • Fax: 804-538-2718
Mailing address:
  • Phone: 540-717-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906015633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: