Healthcare Provider Details

I. General information

NPI: 1235955535
Provider Name (Legal Business Name): LAURA WILCOXEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ACRES CT
LYNCHBURG VA
24502-2539
US

IV. Provider business mailing address

132 ACRES CT
LYNCHBURG VA
24502-2539
US

V. Phone/Fax

Practice location:
  • Phone: 434-262-0165
  • Fax:
Mailing address:
  • Phone: 434-262-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8809-226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704016373
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: