Healthcare Provider Details

I. General information

NPI: 1861647612
Provider Name (Legal Business Name): ELAINE WALTERS MCFERRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 NORTH LYNNHAVEN ROAD B
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

3419 VIRGINIA BEACH BLVD B12
VIRGINIA BEACH VA
23452
US

V. Phone/Fax

Practice location:
  • Phone: 757-486-6515
  • Fax:
Mailing address:
  • Phone: 757-486-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0701000857
License Number StateVA

VIII. Authorized Official

Name: ELAINE WALTERS MCFERRON
Title or Position: FAMILY THERAPIST
Credential: LPC, LMFT
Phone: 757-486-6515