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General NPI Number Information
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NPI Number | 1245782507
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Entity Type | Individual
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Provider Name | WILLIS MARSHALL LICDC-S
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Gender | Male
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 820 S MARTIN LUTHER KING JR BLVD
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City | HAMILTON
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State | OH
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Zip | 45011-3216
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Country | US
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Telephone | 513-868-5147
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Fax |
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Provider Business Mailing Address
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Address Line | 230 LUDLOW ST
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City | HAMILTON
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State | OH
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Zip | 45011-2903
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ICDC.841156-CS
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License Number State | OH
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