| NPI | 1477019974 |
|---|---|
| Former Name | LISA R WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11228) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 001923) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |