Provider Demographics
NPI:1922181668
Name:THOMAS-WILSON, JOANN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:M
Last Name:THOMAS-WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:M
Other - Last Name:THOMAS-WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 24413
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-0413
Mailing Address - Country:US
Mailing Address - Phone:804-275-9980
Mailing Address - Fax:804-275-9981
Practice Address - Street 1:2545 BELLWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-4472
Practice Address - Country:US
Practice Address - Phone:804-275-9980
Practice Address - Fax:804-275-9981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA081498OtherSENTARA
VA007700890Medicaid
VA140896OtherANTHEM
VA2061441OtherCIGNA BEHAVIORAL HEALTH
VA254786000OtherMAGELLAN BEHAVIOR HEALTH
VA5555750OtherAETNA U.S. HEALTHCARE
VA031677OtherVALUE OPTIONS
VA007700890Medicaid