Provider Demographics
NPI:1619606589
Name:WILLIS, JAMES F (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:WILLIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41241
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-1241
Mailing Address - Country:US
Mailing Address - Phone:866-648-7334
Mailing Address - Fax:251-405-3323
Practice Address - Street 1:1156 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3660
Practice Address - Country:US
Practice Address - Phone:866-648-7334
Practice Address - Fax:251-405-3323
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL257843Medicaid