Provider Demographics
NPI:1245412097
Name:WILLIS, WANDA JEANETTE (MAED LPC)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:JEANETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MAED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:MACON COUNTY SCHOOLS
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28744-1029
Mailing Address - Country:US
Mailing Address - Phone:828-524-3314
Mailing Address - Fax:828-369-7240
Practice Address - Street 1:1202 OLD MURPHY RD
Practice Address - Street 2:MACON COUNTY SCHOOLS
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-9111
Practice Address - Country:US
Practice Address - Phone:828-524-3314
Practice Address - Fax:828-369-7240
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional