MEDICARE: DR. SOPHIA SILLS-TAILOR PH.D, LPCMH, LPC,

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	101YP2500X	Professional Counselor	PRC15540	DC
2	101YP2500X	Professional Counselor	0701006106	VA
3	101YS0200X	School Counselor	651764	NJ
4	101YM0800X	Mental Health Counselor	PC-0000586	DE

General Provider Information

NPI Number	:	1659711711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA SILLS-TAILOR PH.D, LPCMH, LPC,

Provider Business Mailing Address
First Line	:	748 ALDER CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4858
Country	:	US
Telephone Number	:	757-724-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5505 INDIAN RIVER RD
Second Line	:	SUITE 100
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5252
Country	:	US
Telephone Number	:	757-724-0980
Fax Number	:

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

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	08/18/2025

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