Healthcare Provider Details

I. General information

NPI: 1952228355
Provider Name (Legal Business Name): ERIK WILLIS, MA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
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 Number
License Number State

VIII. Authorized Official

Name: ERIK HAYWARD WILLIS
Title or Position: OWNER
Credential:
Phone: 802-730-5757