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General NPI Number Information
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NPI Number | 1528429248
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Entity Type | Individual
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Provider Name | AUDREY WILLS
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Gender | Female
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 17002 PACIFIC AVE S
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City | SPANAWAY
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State | WA
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Zip | 98387-8253
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Country | US
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Telephone | 253-538-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 17002 PACIFIC AVE S
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City | SPANAWAY
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State | WA
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Zip | 98387-8253
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Country | US
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Telephone | 253-538-2323
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CO60524751
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License Number State | WA
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