Healthcare Provider Details

I. General information

NPI: 1144975574
Provider Name (Legal Business Name): ELIZABETH ASHLEY HUPP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ASHLEY MILLER LCSW

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 CLOVERDALE RD
ROANOKE VA
24019-8221
US

IV. Provider business mailing address

212 WHITEFIELD CT
SALEM VA
24153-4324
US

V. Phone/Fax

Practice location:
  • Phone: 540-966-5808
  • Fax:
Mailing address:
  • Phone: 540-339-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: