Provider Demographics
NPI:1780705301
Name:WILLSON, GENEVIEVE MARIE (MA, LPC, ATR-BC, NCC)
Entity type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:MARIE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC, NCC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:471 W SOUTH ST
Mailing Address - Street 2:THE MARLBOROUGH BUILDING SUITE 41A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4678
Mailing Address - Country:US
Mailing Address - Phone:269-270-2322
Mailing Address - Fax:269-624-1997
Practice Address - Street 1:471 W SOUTH ST
Practice Address - Street 2:THE MARLBOROUGH BUILDING SUITE 41A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4678
Practice Address - Country:US
Practice Address - Phone:269-270-2322
Practice Address - Fax:269-624-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional