Provider Demographics
NPI:1275848723
Name:WILLIS, LIONEL ELBERT III (LPC)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:ELBERT
Last Name:WILLIS
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 GREENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6456
Mailing Address - Country:US
Mailing Address - Phone:910-798-3500
Mailing Address - Fax:910-798-7834
Practice Address - Street 1:1650 GREENFIELD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6456
Practice Address - Country:US
Practice Address - Phone:910-798-3500
Practice Address - Fax:910-798-7834
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104607Medicaid