Healthcare Provider Details

I. General information

NPI: 1346398484
Provider Name (Legal Business Name): GEORGE ALAN WILLARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HIGHLAND CIR
BLACKSBURG VA
24060-5619
US

IV. Provider business mailing address

1100 HIGHLAND CIRCLE
BLACKSBURG VA
24060
US

V. Phone/Fax

Practice location:
  • Phone: 540-808-3013
  • Fax:
Mailing address:
  • Phone: 540-808-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2324
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: