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NPI Code Detail

MEDICARE: LANITA RENEE WILLIS LSW, LICDC

MEDICARE: LANITA RENEE WILLIS LSW, LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor161032OH

General Provider Information

NPI Number : 1316446685
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANITA RENEE WILLIS LSW, LICDC
Provider Business Mailing Address
First Line : 5471 SCIOTO DARBY RD
Second Line :
City : HILLIARD
State : OH
Zip : 43026-1310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2323 LAKE CLUB DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43232-3101
Country : US
Telephone Number : 380-242-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2018
Last Update Date : 11/18/2025

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