Provider Demographics
NPI:1790261873
Name:MASON, WESLEY NATHANIEL (MED)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:NATHANIEL
Last Name:MASON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STRAWBERRY PLAINS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-3442
Mailing Address - Country:US
Mailing Address - Phone:757-904-2406
Mailing Address - Fax:
Practice Address - Street 1:500 STRAWBERRY PLAINS RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3442
Practice Address - Country:US
Practice Address - Phone:757-904-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty