Individual
VILLEY IVAN TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 E MAIN ST STE 1600, NORFOLK, VA 23510-2206
(757) 737-3560
Mailing address
500 E MAIN ST STE 1600, NORFOLK, VA 23510-2206
(757) 737-3560
(844) 238-9831
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133001995
VA
Other
Enumeration date
10/31/2016
Last updated
02/20/2026
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