Provider Demographics
NPI:1750727038
Name:WILLIS, VICKIE LAVETTE (LPC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LAVETTE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:LAVETTE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25900 GREENFIELD RD STE 415
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1267
Mailing Address - Country:US
Mailing Address - Phone:313-671-0141
Mailing Address - Fax:
Practice Address - Street 1:25900 GREENFIELD RD STE 415
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1267
Practice Address - Country:US
Practice Address - Phone:313-671-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health