| Doctor Name: | LISA B. WILLSON |
| NPI Number: | 1437482221 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CASAC-T |
| License Number: | 21373 |
| Business Practice Address: | 1062 State Route 38 Owego, NY - 13827 |
| Business Phone Number: | 6076874000 |
| Business Fax Number: | 6076876396 |
| Mailing Address: | 1062 State Route 38, Po Box 177 OWEGO |
| State: | NY |
| Postal Code: | 13827 |
| Phone Number: | 6076874000 |
| Fax Number: | 6076876396 |
| NPI Enumeration Date: | 09/10/2009 |
| NPI Last Update Date: | 09/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 21373 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |