| NPI | 1699947804 |
|---|---|
| Former Name | STACEY L WILLIS-CENTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2008007986) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY6345) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2015-07-23 |