Individual
CHARNELLE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 NW LAKE WHITNEY PL, PORT ST LUCIE, FL 34986-1605
(772) 337-8164
Mailing address
4977 NW FOXWORTH AVE, PORT ST LUCIE, FL 34983-2302
(954) 815-6241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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