Individual
MS. MARY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4656 BRAMBLETON AVENUE, ROANOKE, VA 24018
(540) 772-8043
(540) 772-8242
Mailing address
755 INDEPENDENCE BLVD, CHRISTIANSBURG, VA 24073
(540) 392-0711
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003372
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
087515M
SOUTHERN HEALTH
VA
01
—
191801
ANTHEM BCBS
VA
01
—
488754
VALUE OPTIONS
VA
01
—
7684485
AETNA
TX
Enumeration date
10/04/2006
Last updated
07/09/2007
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