Individual
TIAIRA MIKAL WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 KILPATRICK BLVD STE 100, MONROE, LA 71201-5156
(318) 325-8050
Mailing address
3100 KILPATRICK BLVD STE 100, MONROE, LA 71201-5156
(318) 325-8050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
90118
TX
101YP2500X
Professional Counselor
Primary
7684
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/31/2017
Last updated
06/10/2024
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