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General NPI Number Information
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NPI Number | 1811449382
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Entity Type | Individual
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Provider Name | VILLEY IVAN TIDWELL
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Gender | Male
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 500 E MAIN ST STE 1600
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City | NORFOLK
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State | VA
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Zip | 23510-2206
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Country | US
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Telephone | 757-737-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E MAIN ST STE 1600
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City | NORFOLK
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State | VA
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Zip | 23510-2206
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Country | US
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Telephone | 757-737-3560
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Fax | 844-238-9831
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133001995
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License Number State | VA
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