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General NPI Number Information
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NPI Number | 1255620746
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Entity Type | Individual
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Provider Name | ROBERT A. WILLIS MA
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Gender | Male
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 204 JEFFERSON ST SUITE 106
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City | N WILKESBORO
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State | NC
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Zip | 28659-3586
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Country | US
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Telephone | 336-838-1644
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Fax | 336-667-7720
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Provider Business Mailing Address
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Address Line | PO BOX 1656
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City | N WILKESBORO
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State | NC
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Zip | 28659-1656
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Country | US
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Telephone | 336-838-1644
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Fax | 336-667-7720
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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