Healthcare Provider Details

I. General information

NPI: 1033395694
Provider Name (Legal Business Name): KERI WILLIS-HIGGONS L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3301
US

IV. Provider business mailing address

1101 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3301
US

V. Phone/Fax

Practice location:
  • Phone: 757-344-1701
  • Fax: 757-644-1476
Mailing address:
  • Phone: 757-344-1701
  • Fax: 757-644-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701003614
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: