Individual
ANITA M WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, COTP
Contact information
Practice address
2103 E PARHAM RD, SUITE 100, RICHMOND, VA 23228-2235
(804) 261-2090
Mailing address
PO BOX 538622, ATLANTA, GA 30353-8622
(910) 742-9243
(888) 746-1787
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0812000510
VA
1041C0700X
Clinical Social Worker
Primary
0904003558
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004942418
—
VA
05
—
010050499
—
VA
05
—
010063752
—
VA
Enumeration date
01/15/2007
Last updated
08/29/2018
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