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General NPI Number Information
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NPI Number | 1407122948
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Entity Type | Individual
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Provider Name | RENEE WILLIS LPC, RPT, NCC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 109 CENTRAL AVE
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3905
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Country | US
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Telephone | 657-229-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 30 WETLANDS RD
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City | WHITE
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State | GA
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Zip | 30184-2885
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Country | US
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Telephone | 657-229-0679
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008460
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License Number State | GA
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