Individual
WILLIAM WELLBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 526-1364
Mailing address
2825 JEFFERSON ST SW, ROANOKE, VA 24014-3319
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810-002556
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7709129
—
VA
Enumeration date
01/18/2006
Last updated
10/18/2018
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