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General NPI Number Information
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NPI Number | 1063406478
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Entity Type | Individual
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Provider Name | WILLIAM L MULLIGAN PHD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/07/2012
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Provider Practice Location Address
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Address Line | 1403 GREENBRIER PKWY SUITE 215
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0614
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Country | US
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Telephone | 757-410-0700
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Fax | 757-222-3384
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Provider Business Mailing Address
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Address Line | PO BOX 4085
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-0085
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Country | US
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Telephone | 757-410-0700
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Fax | 757-222-3384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810000729
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License Number State | VA
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