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General NPI Number Information
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NPI Number | 1134800659
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Entity Type | Individual
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Provider Name | KEYSHA NICOLE WILLIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 4360 CHAMBLEE DUNWOODY RD STE 515
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City | ATLANTA
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State | GA
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Zip | 30341-1076
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Country | US
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Telephone | 404-974-9052
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Fax |
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Provider Business Mailing Address
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Address Line | 2441 QUINCY LOOP
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City | FAIRBURN
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State | GA
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Zip | 30213-4542
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Country | US
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Telephone | 404-276-7296
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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