MEDICARE: WANDA WILLARD HILL LCSW, CSOTP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904005735	VA

General Provider Information

NPI Number	:	1225042450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA WILLARD HILL LCSW, CSOTP

Provider Business Mailing Address
First Line	:	7713 WHIRLAWAY DR
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-1534
Country	:	US
Telephone Number	:	804-519-5988
Fax Number	:	804-323-2501

Provider Business Practice Location Address
First Line	:	5412 GLENSIDE DR STE F
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-3995
Country	:	US
Telephone Number	:	804-282-5880
Fax Number	:	804-288-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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