Active NPI
William Wellborn, PHD
- Clinical Psychologist
- Roanoke, VA
National Provider Identifier
1467432450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810-002556
- Practice address
- 3 Riverside Cir
Roanoke, VA 24016-4955 - Phone
- (540) 526-1364
- NPI assigned
- Jan 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810-002556 | VA | Primary |
Addresses
Primary practice location
3 Riverside Cir
Roanoke, VA 24016-4955
Mailing address
2825 Jefferson St SW
Roanoke, VA 24014-3319
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7709129 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810-002556 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539820800000",
"number": "1467432450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2825 JEFFERSON ST SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240143319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 RIVERSIDE CIR",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240164955",
"telephone_number": "540-526-1364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLBORN",
"first_name": "WILLIAM",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2018-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810-002556",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7709129",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.