Individual
CHARLESETTA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHA, MS, RN
Contact information
Practice address
4145 COLUMBIA RD, MARTINEZ, GA 30907-5400
(706) 869-7373
Mailing address
860 WILLOW LK, EVANS, GA 30809-8000
(706) 524-3690
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
163W00000X
Registered Nurse
RN219487
GA
Other
Enumeration date
03/22/2022
Last updated
10/13/2022
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