Individual
MR. WILLIAM MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHP
Contact information
Practice address
5833 RICHMOND TAPPAHANNOCK HWY # 108, AYLETT, VA 23009-3007
(804) 387-0426
Mailing address
5833 RICHMOND TAPPAHANNOCK HWY # 108, AYLETT, VA 23009-3007
(804) 387-0426
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2063
VA
Other
Enumeration date
08/20/2013
Last updated
08/21/2013
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