Provider Demographics
NPI:1124548698
Name:WILMER, MEREDITH TAYLOR (PHD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:TAYLOR
Last Name:WILMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:TAYLOR
Other - Last Name:DRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1487 CHAIN BRIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5723
Mailing Address - Country:US
Mailing Address - Phone:703-908-1020
Mailing Address - Fax:
Practice Address - Street 1:1487 CHAIN BRIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5723
Practice Address - Country:US
Practice Address - Phone:703-908-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD718654103TB0200X
DCPSY1001554103TB0200X
MA11088103TC2200X
VA0810006298103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent