MEDICARE: LANITA RENEE WILLIS LSW, LICDC

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	101Y00000X	Counselor	161032	OH

General Provider Information

NPI Number	:	1316446685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANITA RENEE WILLIS LSW, LICDC

Provider Business Mailing Address
First Line	:	5471 SCIOTO DARBY RD
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-1310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 LAKE CLUB DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3101
Country	:	US
Telephone Number	:	380-242-2900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2018
Last Update Date	:	11/18/2025

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