Provider Demographics
NPI:1720511439
Name:WILLIS, ROBI RAE (BA/CDP)
Entity Type:Individual
Prefix:
First Name:ROBI
Middle Name:RAE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:BA/CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2095
Mailing Address - Country:US
Mailing Address - Phone:509-324-1427
Mailing Address - Fax:509-327-0163
Practice Address - Street 1:1101 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2010
Practice Address - Country:US
Practice Address - Phone:509-324-1427
Practice Address - Fax:509-327-0163
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60068238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)