Healthcare Provider Details

I. General information

NPI: 1871176958
Provider Name (Legal Business Name): CARLENE D. WILLIS LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BEECH AVE
TIVERTON RI
02878-1412
US

IV. Provider business mailing address

124 BEECH AVE
TIVERTON RI
02878-1412
US

V. Phone/Fax

Practice location:
  • Phone: 401-662-3143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMHC00227
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: