Provider Demographics
NPI:1861647455
Name:BLAIR, WILLIAM ANTHONY ANDERSON JR (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY ANDERSON
Last Name:BLAIR
Suffix:JR
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 1:803 DAVID DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6402
Mailing Address - Country:US
Mailing Address - Phone:619-796-5263
Mailing Address - Fax:888-527-7925
Practice Address - Street 1:803 DAVID DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6402
Practice Address - Country:US
Practice Address - Phone:334-332-6540
Practice Address - Fax:888-527-7925
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004370103T00000X
CAPSY-35278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist