Provider Demographics
NPI:1396595476
Name:WILLIS, LAUNDREA E
Entity type:Individual
Prefix:
First Name:LAUNDREA
Middle Name:E
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12807 N AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3359
Mailing Address - Country:US
Mailing Address - Phone:600-500-8207
Mailing Address - Fax:
Practice Address - Street 1:12807 N AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3359
Practice Address - Country:US
Practice Address - Phone:313-707-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health