Doctor Name: | VIRGINIA LYNN WILLIS |
NPI Number: | 1174839641 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 6221-C |
Business Practice Address: | 1101 Morgan Street Suite 8 Paragould, AR - 724503949 |
Business Phone Number: | 8703359483 |
Business Fax Number: | 8703359487 |
Mailing Address: | 1815 Pleasant Grove Rd, JONESBORO |
State: | AR |
Postal Code: | 724017870 |
Phone Number: | 8709336886 |
Fax Number: | 8709339395 |
NPI Enumeration Date: | 08/23/2010 |
NPI Last Update Date: | 02/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6221-C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |