Provider Demographics
NPI:1225042450
Name:HILL, WANDA WILLARD (LCSW, CSOTP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:WILLARD
Last Name:HILL
Suffix:
Gender:F
Credentials:LCSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 WHIRLAWAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1534
Mailing Address - Country:US
Mailing Address - Phone:804-519-5988
Mailing Address - Fax:804-323-2501
Practice Address - Street 1:5412 GLENSIDE DR STE F
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3995
Practice Address - Country:US
Practice Address - Phone:804-282-5880
Practice Address - Fax:804-288-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical