Provider Demographics
NPI:1346398484
Name:WILLARD, GEORGE ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALAN
Last Name:WILLARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HIGHLAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060
Mailing Address - Country:US
Mailing Address - Phone:540-808-3013
Mailing Address - Fax:
Practice Address - Street 1:1100 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5619
Practice Address - Country:US
Practice Address - Phone:540-808-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0107106H00000X
VA2324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist