Healthcare Provider Details

I. General information

NPI: 1194219618
Provider Name (Legal Business Name): ERIC RUSSELL WARD MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 01/16/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MCLAWS CIR
WILLIAMSBURG VA
23185-5649
US

IV. Provider business mailing address

2202 EXECUTIVE DR STE C
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-3100
  • Fax:
Mailing address:
  • Phone: 757-256-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: