Provider Demographics
NPI:1831376565
Name:WILLISON, ARTHUR W (MA, LCPC)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:W
Last Name:WILLISON
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7031
Mailing Address - Country:US
Mailing Address - Phone:301-777-0633
Mailing Address - Fax:310-777-0625
Practice Address - Street 1:113 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7031
Practice Address - Country:US
Practice Address - Phone:301-777-0633
Practice Address - Fax:310-777-0625
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2243101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional