Provider Demographics
NPI:1861180523
Name:WOLCOTT, KEARRA E
Entity type:Individual
Prefix:
First Name:KEARRA
Middle Name:E
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 KAISER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1335
Mailing Address - Country:US
Mailing Address - Phone:540-429-1916
Mailing Address - Fax:
Practice Address - Street 1:609 HARBOR SIDE ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5419
Practice Address - Country:US
Practice Address - Phone:703-896-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician