Provider Demographics
NPI:1174836779
Name:WILLS, MIRIAM SUZANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:SUZANNE
Last Name:WILLS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 WHIRLAWAY CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2144
Mailing Address - Country:US
Mailing Address - Phone:865-539-2545
Mailing Address - Fax:
Practice Address - Street 1:6311 KINGSTON PIKE
Practice Address - Street 2:SUITE 28W
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1177103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling