Provider Demographics
NPI:1285759811
Name:WOLCOTT, ELIZABETH A (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SEMINOLE BLVD
Mailing Address - Street 2:B-112
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-8124
Mailing Address - Country:US
Mailing Address - Phone:727-518-7294
Mailing Address - Fax:727-584-4937
Practice Address - Street 1:3816 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8900
Practice Address - Country:US
Practice Address - Phone:813-961-2518
Practice Address - Fax:813-265-8341
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ069XOtherBLUE SHIELD NUMBER