Healthcare Provider Details

I. General information

NPI: 1316366768
Provider Name (Legal Business Name): VALERIE WILLIS, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MERCHANT ST
AUDUBON NJ
08106-1424
US

IV. Provider business mailing address

108 W MERCHANT ST
AUDUBON NJ
08106-1424
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-0664
  • Fax: 856-546-1480
Mailing address:
  • Phone: 856-546-0664
  • Fax: 856-546-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00346500
License Number StateNJ

VIII. Authorized Official

Name: MRS. VALERIE WILLIS
Title or Position: THERAPIST
Credential: LPC
Phone: 856-546-0664