MEDICARE: ELIZABETH ALICE MAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	0704016420	VA

General Provider Information

NPI Number	:	1043715261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ALICE MAY

Provider Business Mailing Address
First Line	:	6426 EASTLEIGH CT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2425
Country	:	US
Telephone Number	:	703-405-2679
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 PRINCE WILLIAM PKWY STE 301
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-7667
Country	:	US
Telephone Number	:	703-497-1771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	09/13/2024

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