Provider Demographics
NPI:1720707748
Name:KIMYETTE Y. WILLIS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:KIMYETTE Y. WILLIS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMYETTE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-860-8798
Mailing Address - Street 1:225 WILMINGTON W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9011
Mailing Address - Country:US
Mailing Address - Phone:484-860-8798
Mailing Address - Fax:
Practice Address - Street 1:225 WILMINGTON W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9011
Practice Address - Country:US
Practice Address - Phone:484-860-8798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty