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NPI Code Detail

MEDICARE: MRS. ASHLEY ALICIA WILLIS LCSWC

MEDICARE: MRS. ASHLEY ALICIA WILLIS LCSWC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker17988MD

General Provider Information

NPI Number : 1124490776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY ALICIA WILLIS LCSWC
Provider Business Mailing Address
First Line : 4779 CLAIRELEE DR
Second Line :
City : OWINGS MILLS
State : MD
Zip : 21117-4759
Country : US
Telephone Number : 443-386-4897
Fax Number :
Provider Business Practice Location Address
First Line : 100 OWINGS CT STE 12
Second Line :
City : REISTERSTOWN
State : MD
Zip : 21136-6434
Country : US
Telephone Number : 443-386-4897
Fax Number : 443-640-4358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2015
Last Update Date : 08/31/2020

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Directions to “ MRS. ASHLEY ALICIA WILLIS LCSWC” Practice Location

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