Basic Information
| Provider Information | |||||||||
| NPI: | 1609984483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ALBERT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18274 CAMDENHURST DR | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201556252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037541531 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE STE 302 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0701003231 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 293820 | 01 | VA | AMERIGROUP | OTHER | 384563 | 01 | VA | ANTHEM LEESBURG | OTHER | 384564 | 01 | VA | ANTHEM ELMHC | OTHER |