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General NPI Number Information
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NPI Number | 1477962421
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Entity Type | Organization
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Legal Business Name | WELLSPRING CHILD AND FAMILY PSYCHOLOGY, PC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 615 EMANCIPATION HWY STE 101
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8407
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Country | US
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Telephone | 540-693-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 615 EMANCIPATION HWY STE 101
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8407
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Country | US
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Telephone | 540-693-0096
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | DR. ELISABETH MARGARET JEROME
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Credential | PH.D.
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Telephone | 540-478-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004284
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License Number State | VA
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