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General NPI Number Information
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NPI Number | 1134695588
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Entity Type | Individual
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Provider Name | WILLIAM CHRISTOPHER WILLIS JR. LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 877 BALTIMORE ANNAPOLIS BLVD STE 308
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City | SEVERNA PARK
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State | MD
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Zip | 21146-4716
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Country | US
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Telephone | 667-777-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 7626 MARCY DR
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City | GLEN BURNIE
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State | MD
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Zip | 21060-7662
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Country | US
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Telephone | 443-850-7962
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 24338
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License Number State | MD
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