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General NPI Number Information
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NPI Number | 1093787970
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Entity Type | Individual
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Provider Name | BRIAN K WALD PSY D
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1 COLUMBUS CTR STE 600
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6722
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Country | US
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Telephone | 757-333-7501
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Fax | 757-490-7804
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Provider Business Mailing Address
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Address Line | 1 COLUMBUS CTR STE 600
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6722
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Country | US
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Telephone | 757-333-7501
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Fax | 757-490-7804
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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 | 0810001650
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License Number State | VA
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