Provider Demographics
NPI:1275590689
Name:WILLARD, DEBRA (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD
Mailing Address - Street 2:STE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6818
Mailing Address - Country:US
Mailing Address - Phone:517-346-8410
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:812 E JOLLY RD
Practice Address - Street 2:STE G14
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6818
Practice Address - Country:US
Practice Address - Phone:517-237-7350
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM6401005757101YP2500X
MI6401005757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional