Provider Demographics
NPI:1679987648
Name:WILLIS, LINNEA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LINNEA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S. CLINTON ST.
Mailing Address - Street 2:MAILSTOP CT 05-13
Mailing Address - City:CANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-953-1883
Mailing Address - Fax:
Practice Address - Street 1:7141 ROLLING BEND RD
Practice Address - Street 2:D
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2359
Practice Address - Country:US
Practice Address - Phone:301-408-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional