Provider Demographics
NPI:1285220277
Name:WILLIS, BRITNEY ANN (RADT SUBSTA)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:ANN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RADT SUBSTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3904
Mailing Address - Country:US
Mailing Address - Phone:916-453-1482
Mailing Address - Fax:
Practice Address - Street 1:8401 JACKSON RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3904
Practice Address - Country:US
Practice Address - Phone:916-453-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102487101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)