Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 0810006298 | VA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 718654 | MD |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY1001554 | DC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 11088 | MA |
NPI | 1124548698 |
---|---|
Provider Name | Meredith Taylor Wilmer |
First Address | Mc Lean, VA 22101-5723 |
Second Address | Mc Lean, VA 22101-5723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 31/03/2020 |