Individual
MR. DALE WAYNE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
305 W CHESAPEAKE AVE STE 300, TOWSON, MD 21204-4440
(410) 828-6619
Mailing address
143 LONG DR, ELKTON, MD 21921-3691
(410) 392-3171
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06770
MD
Other
Enumeration date
08/01/2006
Last updated
01/19/2011
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