Provider Demographics
NPI:1770717696
Name:WILLIS, TONI (LMHC)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 BOWLINE DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0558
Mailing Address - Country:US
Mailing Address - Phone:845-863-5303
Mailing Address - Fax:
Practice Address - Street 1:495 BOWLINE DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-0558
Practice Address - Country:US
Practice Address - Phone:845-863-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004381101YM0800X
NC17548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health