Provider Demographics
NPI:1770319402
Name:WILLIS, CHRISTINA J (LPCA)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:KRISI
Other - Middle Name:J
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCA
Mailing Address - Street 1:PO BOX 735566
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5566
Mailing Address - Country:US
Mailing Address - Phone:800-288-7750
Mailing Address - Fax:
Practice Address - Street 1:5050 QUORUM DR STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-1410
Practice Address - Country:US
Practice Address - Phone:800-288-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional