MEDICARE: WILLIS ADOLECANT & ADULT SERVICES

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	351	NC
2	101YM0800X	Mental Health Counselor		NC

General Provider Information

NPI Number	:	1154448223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS ADOLECANT & ADULT SERVICES

Provider Business Mailing Address
First Line	:	6101 IDLEWILD RD
Second Line	:	STE. 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 ASHLEY RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-3714
Country	:	US
Telephone Number	:	704-614-0042
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SARAH WILLIS
Credential	:
Telephone Number	:	704-614-0042

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/11/2025

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