Healthcare Provider Details

I. General information

NPI: 1831991082
Provider Name (Legal Business Name): TERESE S ELAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESE SHENELL ELAM

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 ROCK LANDING DR STE 101
NEWPORT NEWS VA
23606-4394
US

IV. Provider business mailing address

11818 ROCK LANDING DR STE 101
NEWPORT NEWS VA
23606-4394
US

V. Phone/Fax

Practice location:
  • Phone: 757-595-3900
  • Fax: 757-595-0649
Mailing address:
  • Phone: 757-595-3900
  • Fax: 757-595-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017949
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: