Provider Demographics
NPI:1881790319
Name:WILLS, PATRICIA ANN (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WILLS
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 1:2624 SOUTHERN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7433
Mailing Address - Country:US
Mailing Address - Phone:757-235-4900
Mailing Address - Fax:757-498-5452
Practice Address - Street 1:2624 SOUTHERN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7433
Practice Address - Country:US
Practice Address - Phone:757-235-4900
Practice Address - Fax:757-498-5452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08001950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007700946Medicaid