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General NPI Number Information
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NPI Number | 1780705301
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Entity Type | Individual
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Provider Name | GENEVIEVE MARIE WILLSON MA, LPC, ATR-BC, NCC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/29/2016
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Provider Practice Location Address
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Address Line | 471 W SOUTH ST THE MARLBOROUGH BUILDING SUITE 41A
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City | KALAMAZOO
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State | MI
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Zip | 49007-4678
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Country | US
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Telephone | 269-270-2322
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Fax | 269-624-1997
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Provider Business Mailing Address
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Address Line | 471 W SOUTH ST THE MARLBOROUGH BUILDING SUITE 41A
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City | KALAMAZOO
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State | MI
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Zip | 49007-4678
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Country | US
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Telephone | 269-270-2322
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Fax | 269-624-1997
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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 | 6401010724
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License Number State | MI
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