Healthcare Provider Details

I. General information

NPI: 1164933941
Provider Name (Legal Business Name): VONDA WILLIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 HARVEY AVE
CINCINNATI OH
45229-3000
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-8227
  • Fax: 513-585-8278
Mailing address:
  • Phone: 513-245-3600
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number17000262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: