Provider Demographics
NPI:1316366768
Name:VALERIE WILLIS, LPC, LLC
Entity Type:Organization
Organization Name:VALERIE WILLIS, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-546-0664
Mailing Address - Street 1:108 W MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1424
Mailing Address - Country:US
Mailing Address - Phone:856-546-0664
Mailing Address - Fax:856-546-1480
Practice Address - Street 1:108 W MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1424
Practice Address - Country:US
Practice Address - Phone:856-546-0664
Practice Address - Fax:856-546-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00346500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty