Provider Demographics
NPI:1639252919
Name:EDWARD H TILLER PHD PC
Entity Type:Organization
Organization Name:EDWARD H TILLER PHD PC
Other - Org Name:WILLIAMSBURG CENTRE FOR THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-253-0371
Mailing Address - Street 1:217 MCLAWS CIRCLE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5855
Mailing Address - Country:US
Mailing Address - Phone:757-253-0371
Mailing Address - Fax:757-253-8063
Practice Address - Street 1:217 MCLAWS CIRCLE
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5855
Practice Address - Country:US
Practice Address - Phone:757-253-0371
Practice Address - Fax:757-253-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty