Individual
CHANTEL E WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 COALFIELD RD, MIDLOTHIAN, VA 23114-4403
(804) 897-7440
Mailing address
400 COALFIELD RD, MIDLOTHIAN, VA 23114-4403
(804) 897-7440
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-22-202941
REGISTERED BEHAVIOR TECHNICIAN
VA
Enumeration date
07/08/2022
Last updated
07/08/2022
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