Provider Demographics
NPI:1063406478
Name:MULLIGAN, WILLIAM L (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4085
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-0085
Mailing Address - Country:US
Mailing Address - Phone:757-410-0700
Mailing Address - Fax:757-222-3384
Practice Address - Street 1:1403 GREENBRIER PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0614
Practice Address - Country:US
Practice Address - Phone:757-410-0700
Practice Address - Fax:757-222-3384
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA172017, 267207OtherANTHEM, BC/BS
VA2149701OtherUBH
54-1088477OtherTRICARE
VA54-1088477OtherVIRGINIA HEALTH NETWORK
VA54-1088477OtherAETNA
031538OtherVALUE OPTIONS
VA089211, 37077OtherOPTIMAHEALTH
VA11240084OtherCAQH
VA2166701OtherCBH
VA2149701OtherUBH
00Y139W01Medicare PIN