Provider Demographics
NPI:1336366061
Name:WILLIAM L MULLIGAN PHD PC
Entity Type:Organization
Organization Name:WILLIAM L MULLIGAN PHD PC
Other - Org Name:COGNITIVE BEHAVIOR THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-410-0700
Mailing Address - Street 1:PO BOX 4805
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-0805
Mailing Address - Country:US
Mailing Address - Phone:757-410-0700
Mailing Address - Fax:757-222-3384
Practice Address - Street 1:1403 GREENBRIER PKWY STE 215
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0608
Practice Address - Country:US
Practice Address - Phone:757-410-0700
Practice Address - Fax:757-222-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C10849OtherMEDICARE PTAN