Provider Demographics
NPI:1366681835
Name:WILLIS, VALERIE
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 JUNIPERO AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-1422
Mailing Address - Country:US
Mailing Address - Phone:323-242-7632
Mailing Address - Fax:
Practice Address - Street 1:15201 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4048
Practice Address - Country:US
Practice Address - Phone:310-706-0200
Practice Address - Fax:310-706-0202
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)