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General NPI Number Information
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NPI Number | 1033904230
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Entity Type | Individual
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Provider Name | ELISE WISE
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1 BOARS HEAD PL STE 230
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4628
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Country | US
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Telephone | 434-996-0475
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Fax |
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Provider Business Mailing Address
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Address Line | 761 PARK RIDGE DR
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City | CROZET
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State | VA
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Zip | 22932-3266
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Country | US
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Telephone | 434-996-0475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0704017797
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License Number State | VA
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