Healthcare Provider Details

I. General information

NPI: 1326909052
Provider Name (Legal Business Name): ELAINE HAISLIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 HICKORY FORK RD
GLOUCESTER VA
23061-4033
US

IV. Provider business mailing address

2885 HICKORY FORK RD
GLOUCESTER VA
23061-4033
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-1499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: