Provider Demographics
NPI:1902993900
Name:CONTNER WILKINS, ELISHA MORGAN (MS, LMFT, CEDS)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:MORGAN
Last Name:CONTNER WILKINS
Suffix:
Gender:F
Credentials:MS, LMFT, CEDS
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:MORGAN
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:411 ROSENEATH RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2324
Mailing Address - Country:US
Mailing Address - Phone:407-353-6209
Mailing Address - Fax:
Practice Address - Street 1:6627 W BROAD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1732
Practice Address - Country:US
Practice Address - Phone:804-774-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1946106H00000X
VA0717001305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762601100Medicaid