Provider Demographics
NPI:1942603204
Name:WILLARD, VICTORIA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:W
Last Name:WILLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MAIL STOP 740
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-5336
Mailing Address - Fax:901-595-4701
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:MAIL STOP 740
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-5336
Practice Address - Fax:901-595-4701
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3092103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent