Individual
TRAVIS WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1477 NC 24-87, CAMERON, NC 28326-6752
(910) 484-1711
Mailing address
2919 BREEZEWOOD AVE STE 101, FAYETTEVILLE, NC 28303-5283
(910) 484-1711
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-69178
NC
106S00000X
Behavior Technician
11250
NC
Other
Enumeration date
06/17/2021
Last updated
11/14/2023
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