Provider Demographics
NPI:1841396900
Name:R & S WILLIS, INC
Entity Type:Organization
Organization Name:R & S WILLIS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-868-9117
Mailing Address - Street 1:438 E LONG AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3501
Mailing Address - Country:US
Mailing Address - Phone:704-868-9117
Mailing Address - Fax:704-868-9159
Practice Address - Street 1:438 E LONG AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3501
Practice Address - Country:US
Practice Address - Phone:704-868-9117
Practice Address - Fax:704-868-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300313HMedicaid
NC8700462Medicaid
NC5900984Medicaid
NC8300313BMedicaid
NC8300313GMedicaid
NC6102732Medicaid
NC139XCOtherBCBS PROVIDER NUMBER
NC8976031Medicaid
NC6005716Medicaid
NC8300313Medicaid