Provider Demographics
NPI:1669141594
Name:WILVER, NATALIE LAUREN (PHD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LAUREN
Last Name:WILVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LAUREN
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10474 ARMSTRONG ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10474 ARMSTRONG ST STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3648
Practice Address - Country:US
Practice Address - Phone:571-543-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11687-PY-PR103TC0700X
VA0810008182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical