Healthcare Provider Details

I. General information

NPI: 1720996259
Provider Name (Legal Business Name): MRS. LISA STILLER WILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 ROCK CREEK DR
NEW BERN NC
28562-3617
US

IV. Provider business mailing address

272 ROCK CREEK DR
NEW BERN NC
28562-3617
US

V. Phone/Fax

Practice location:
  • Phone: 252-670-7226
  • Fax:
Mailing address:
  • Phone: 252-670-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23375
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: