Individual
DR. WILLIAM DAVID BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1241 MALL DR, RICHMOND, VA 23235-4737
(804) 794-8828
(804) 794-4735
Mailing address
1241 MALL DR, RICHMOND, VA 23235-4737
(804) 794-8828
(804) 794-4735
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1399
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7755163
—
VA
01
—
O39287
ANTHEM PROVIDER NUMBER
—
Enumeration date
07/24/2006
Last updated
07/09/2007
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