Healthcare Provider Details

I. General information

NPI: 1740529866
Provider Name (Legal Business Name): WILLIAMSBURG PROFESSIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5483 MOORETOWN RD
WILLIAMSBURG VA
23188-2108
US

IV. Provider business mailing address

PO BOX 87
LIGHTFOOT VA
23090-0087
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-6400
  • Fax:
Mailing address:
  • Phone: 757-941-5095
  • Fax: 757-565-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. PAUL GILBERT
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 757-941-5095