Healthcare Provider Details

I. General information

NPI: 1467329409
Provider Name (Legal Business Name): ERIK WILLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 DORSET ST STE 8
SOUTH BURLINGTON VT
05403-6240
US

IV. Provider business mailing address

817 VT ROUTE 15
UNDERHILL VT
05489-9714
US

V. Phone/Fax

Practice location:
  • Phone: 802-730-5757
  • Fax:
Mailing address:
  • Phone: 802-730-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0137274
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: