Healthcare Provider Details

I. General information

NPI: 1083644595
Provider Name (Legal Business Name): NANCY A WISEMAN LPC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 MCLAWS CIR STE 2A
WILLIAMSBURG VA
23185-5856
US

IV. Provider business mailing address

213 MCLAWS CIR STE 2A
WILLIAMSBURG VA
23185-5856
US

V. Phone/Fax

Practice location:
  • Phone: 757-784-5606
  • Fax: 757-903-4255
Mailing address:
  • Phone: 757-784-5606
  • Fax: 757-903-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number071700125
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: