Provider Demographics
NPI:1558034678
Name:HILL, ALEXANDER WESLEY
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WESLEY
Last Name:HILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E LORENGO AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-3525
Mailing Address - Country:US
Mailing Address - Phone:804-382-2017
Mailing Address - Fax:
Practice Address - Street 1:2008 GENERAL BOOTH BLVD STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5910
Practice Address - Country:US
Practice Address - Phone:757-301-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-169618106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician