Provider Demographics
NPI:1033234950
Name:DECKER, WILLAIM ALLEN (PH D)
Entity Type:Individual
Prefix:DR
First Name:WILLAIM
Middle Name:ALLEN
Last Name:DECKER
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 POWHATAN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1389
Mailing Address - Country:US
Mailing Address - Phone:703-836-3678
Mailing Address - Fax:703-836-2667
Practice Address - Street 1:1423 POWHATAN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1389
Practice Address - Country:US
Practice Address - Phone:703-836-3678
Practice Address - Fax:703-836-2667
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002331103G00000X, 103TB0200X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA7860001OtherBCBS NCA CAREFIRST
VAR22863Medicare UPIN
VA077344Medicare ID - Type Unspecified