Provider Demographics
NPI:1275308074
Name:WINGFIELD, EMILY NICHOLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:NICHOLE
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BERKLEY PL
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1312
Mailing Address - Country:US
Mailing Address - Phone:434-363-5509
Mailing Address - Fax:
Practice Address - Street 1:100 BERKLEY PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-1312
Practice Address - Country:US
Practice Address - Phone:434-363-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health