Provider Demographics
NPI:1528368214
Name:WILLIS, RENAE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SAINT BRIDES RD W
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2316
Mailing Address - Country:US
Mailing Address - Phone:336-918-4945
Mailing Address - Fax:
Practice Address - Street 1:821 SAINT BRIDES RD W
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2316
Practice Address - Country:US
Practice Address - Phone:336-918-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0057111041C0700X
VA09040092921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical