Individual
DENETRICE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6511 THEA LN, COLUMBUS, GA 31907-2485
(762) 241-7241
Mailing address
6511 THEA LN, COLUMBUS, GA 31907-2485
(762) 241-7241
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000600938A
—
GA
Enumeration date
01/09/2015
Last updated
01/09/2015
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