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NPI Code Detail

MEDICARE: MS. ELAINE POTTER CHAMPION LPC, CSAC, CRC

MEDICARE: MS. ELAINE POTTER CHAMPION LPC, CSAC, CRC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0710101850VA
2101YP2500XProfessional Counselor0701005122VA

General Provider Information

NPI Number : 1144642984
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELAINE POTTER CHAMPION LPC, CSAC, CRC
Provider Business Mailing Address
First Line : 1802 CEDAR HOLLOW CT
Second Line :
City : HENRICO
State : VA
Zip : 23238-3441
Country : US
Telephone Number : 804-310-7620
Fax Number : 804-421-7127
Provider Business Practice Location Address
First Line : 1241 MALL DR
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-4879
Country : US
Telephone Number : 804-310-7620
Fax Number : 804-421-7127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2014
Last Update Date : 01/14/2014

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