Provider Demographics
NPI:1467171371
Name:WILLIS, JOANNA VICTORIA (LLPC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:VICTORIA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2007
Mailing Address - Country:US
Mailing Address - Phone:248-388-2126
Mailing Address - Fax:
Practice Address - Street 1:14031 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2007
Practice Address - Country:US
Practice Address - Phone:248-388-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451011763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional