Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 0810002331 | VA |
N | 103TC0700X | Clinical Psychologist | 0810002331 | VA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0810002331 | VA |
N | 103G00000X | Clinical Psychologist | 0810002331 | VA |
N | 103TC0700X | Clinical Psychologist | 0810002331 | VA |
N | 103TH0100X | Health Service | 0810002331 | VA |
NPI | 1033234950 |
---|---|
Provider Name | Dr. Willaim Allen Decker |
First Address | Alexandria, VA 22314-1389 |
Second Address | Alexandria, VA 22314-1389 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A7860001 | BCBS NCA CAREFIRST (01) | MD |
R22863 | (02) | VA |