Healthcare Provider Details

I. General information

NPI: 1881790319
Provider Name (Legal Business Name): PATRICIA ANN WILLS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 SOUTHERN BLVD STE 102
VIRGINIA BEACH VA
23452-7433
US

IV. Provider business mailing address

2624 SOUTHERN BLVD STE 102
VIRGINIA BEACH VA
23452-7433
US

V. Phone/Fax

Practice location:
  • Phone: 757-235-4900
  • Fax: 757-498-5452
Mailing address:
  • Phone: 757-235-4900
  • Fax: 757-498-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08001950
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: