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NPI Code Detail

MEDICARE: MS. VALERIE ANN WILLIS LPC

MEDICARE: MS. VALERIE ANN WILLIS LPC
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
1101YM0800XMental Health Counselor37PC00346500NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12785982000OTHERNEAMERIHEALTH

General Provider Information

NPI Number : 1538210463
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VALERIE ANN WILLIS LPC
Provider Business Mailing Address
First Line : 42 DELSEA DR S
Second Line :
City : GLASSBORO
State : NJ
Zip : 08028-2621
Country : US
Telephone Number : 856-863-0006
Fax Number : 856-881-7614
Provider Business Practice Location Address
First Line : 42 DELSEA DR S
Second Line :
City : GLASSBORO
State : NJ
Zip : 08028-2621
Country : US
Telephone Number : 856-863-0006
Fax Number : 856-881-7614
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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