Provider Demographics
NPI:1134695588
Name:WILLIS, WILLIAM CHRISTOPHER JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 MARCY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7662
Mailing Address - Country:US
Mailing Address - Phone:443-850-7962
Mailing Address - Fax:
Practice Address - Street 1:1419 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-768-2719
Practice Address - Fax:410-424-2983
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker