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Individual

DR. DIANE E. WILSON CORMICLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
118 AMALFI CT, PURCELLVILLE, VA 20132-5816
(703) 507-1238
(540) 751-9543
Mailing address
118 AMALFI CT, PURCELLVILLE, VA 20132-5816
(703) 507-1238
(540) 751-9543

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001915
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
350778
ANTHEM BCBS PROVIDER
VA
Enumeration date
08/30/2006
Last updated
10/21/2019
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