Provider Demographics
NPI:1396538344
Name:WILLIS, FAITH NOELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:NOELLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:WILLIS
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4537 COTTENDALE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6243
Mailing Address - Country:US
Mailing Address - Phone:563-676-5504
Mailing Address - Fax:563-676-5504
Practice Address - Street 1:4537 COTTENDALE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6243
Practice Address - Country:US
Practice Address - Phone:563-676-5504
Practice Address - Fax:563-676-5504
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0178491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty