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Individual
SHAUNTAE WILLIS
Active
Individual
SHAUNTAE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW, CDP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP 00005642
WA
1041C0700X
Clinical Social Worker
Primary
LW 60003495
WA
Other
Enumeration date
10/28/2008
Last updated
06/22/2021
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