Healthcare Provider Details

I. General information

NPI: 1124548698
Provider Name (Legal Business Name): MEREDITH TAYLOR WILMER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH TAYLOR DRYMAN

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/21/2022
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 CHAIN BRIDGE RD STE 203
MC LEAN VA
22101-5723
US

IV. Provider business mailing address

1487 CHAIN BRIDGE RD STE 203
MC LEAN VA
22101-5723
US

V. Phone/Fax

Practice location:
  • Phone: 703-908-1020
  • Fax:
Mailing address:
  • Phone: 703-908-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number718654
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY1001554
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number11088
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810006298
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: