MEDICARE: PATRICIA ANN WILLS PHD

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	103TC0700X	Clinical Psychologist	08001950	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881790319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN WILLS PHD

Provider Business Mailing Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-235-4900
Fax Number	:	757-498-5452

Provider Business Practice Location Address
First Line	:	2624 SOUTHERN BLVD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7433
Country	:	US
Telephone Number	:	757-235-4900
Fax Number	:	757-498-5452

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	01/30/2023

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