Provider Demographics
NPI:1134767155
Name:VANBUREN, ELESIA S (COUNSELOR)
Entity type:Individual
Prefix:
First Name:ELESIA
Middle Name:S
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RICHMOND HWY UNIT 501
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-5095
Mailing Address - Country:US
Mailing Address - Phone:540-645-8992
Mailing Address - Fax:540-288-0077
Practice Address - Street 1:8 BLOOMINGTON LN
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7727
Practice Address - Country:US
Practice Address - Phone:540-645-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL6068481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty