Healthcare Provider Details

I. General information

NPI: 1255831624
Provider Name (Legal Business Name): ELISABETH KOSTYK MA.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date: 12/09/2025
Reactivation Date: 12/30/2025

III. Provider practice location address

131 STANLEY DR
WILLIAMSBURG VA
23188-2557
US

IV. Provider business mailing address

131 STANLEY DR
WILLIAMSBURG VA
23188-2557
US

V. Phone/Fax

Practice location:
  • Phone: 757-818-5948
  • Fax:
Mailing address:
  • Phone: 757-585-3216
  • Fax: 757-561-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001306
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: