Provider Demographics
NPI:1801164215
Name:WILLARD, PAMELA LEIGH (LPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LEIGH
Last Name:WILLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1306
Mailing Address - Country:US
Mailing Address - Phone:804-200-1601
Mailing Address - Fax:804-521-5575
Practice Address - Street 1:8000 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1306
Practice Address - Country:US
Practice Address - Phone:804-200-1601
Practice Address - Fax:804-521-5575
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992959928Medicaid