Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TS0200X | School Psychologist | ||
Y | 103TS0200X | School Psychologist | 0183000199 | VA |
NPI | 1982102893 |
---|---|
Provider Name | Dr. Travis G Worrell |
First Address | Martinsville, VA 24112-1917 |
Second Address | Martinsville, VA 24112-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 25/01/2018 |