Provider Demographics
NPI:1609413244
Name:WAKEFIELD, HILLARY C (LCSW)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:C
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-0277
Mailing Address - Country:US
Mailing Address - Phone:540-582-3980
Mailing Address - Fax:540-371-3763
Practice Address - Street 1:7424 BROCK RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-2002
Practice Address - Country:US
Practice Address - Phone:540-582-3980
Practice Address - Fax:540-371-3753
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040113881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical