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General NPI Number Information
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NPI Number | 1750337721
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Entity Type | Individual
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Provider Name | PAMELA YVETTE WILLIS LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 5310 OLD COURT RD STE. 308
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5243
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Country | US
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Telephone | 443-804-3707
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Fax | 410-521-1944
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Provider Business Mailing Address
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Address Line | 3930 NEMO RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4041
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Country | US
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Telephone | 443-804-3707
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Fax | 410-521-1944
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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 | 09716
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License Number State | MD
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