Provider Demographics
NPI:1003680844
Name:WILLIS, LAWENDY MEADOWS
Entity Type:Individual
Prefix:
First Name:LAWENDY
Middle Name:MEADOWS
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 OPELIKA RD STE 6 #178
Mailing Address - Street 2:SAME
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-728-7489
Mailing Address - Fax:334-209-2789
Practice Address - Street 1:1013 TUCKER AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-3643
Practice Address - Country:US
Practice Address - Phone:334-728-7489
Practice Address - Fax:334-209-2789
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04486101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor