MEDICARE: ELIZABETH JOHNSTON ADCOCK MSW

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	1041C0700X	Clinical Social Worker	0904009041	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255624672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JOHNSTON ADCOCK MSW

Provider Business Mailing Address
First Line	:	19254 ROGERS CLARK BLVD
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-4010
Country	:	US
Telephone Number	:	804-633-9997
Fax Number	:	540-371-3753

Provider Business Practice Location Address
First Line	:	19254 ROGERS CLARK BLVD
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-4010
Country	:	US
Telephone Number	:	804-633-9997
Fax Number	:	540-371-3753

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

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	08/10/2016

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