Healthcare Provider Details

I. General information

NPI: 1598695744
Provider Name (Legal Business Name): THOMAS JOHN PETRE' WILLS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: T. J. WILLS PHD

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2893 COLLIERSTOWN RD
LEXINGTON VA
24450-6811
US

IV. Provider business mailing address

2893 COLLIERSTOWN RD
LEXINGTON VA
24450-6811
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-7386
  • Fax: 540-463-7823
Mailing address:
  • Phone: 540-463-7386
  • Fax: 540-463-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0675463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: