Active NPI
Elise Wise
- Counselor
- Charlottesville, VA
National Provider Identifier
1033904230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0704017797
- Practice address
- 1 Boars Head PL Ste 230
Charlottesville, VA 22903-4628 - Phone
- (434) 996-0475
- NPI assigned
- Apr 10, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0704017797 | VA | Primary |
Addresses
Primary practice location
1 Boars Head PL Ste 230
Charlottesville, VA 22903-4628
Mailing address
761 Park Ridge Dr
Crozet, VA 22932-3266
Phone (434) 996-0475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0704017797 | VA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1744243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744243200000",
"number": "1033904230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "761 PARK RIDGE DR",
"city": "CROZET",
"state": "VA",
"postal_code": "229323266",
"telephone_number": "434-996-0475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOARS HEAD PL STE 230",
"city": "CHARLOTTESVILLE",
"state": "VA",
"postal_code": "229034628",
"telephone_number": "434-996-0475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "ELISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-10",
"last_updated": "2025-04-10",
"certification_date": "2025-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0704017797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlottesville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.