Individual
BERNARD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 W COLONIAL DR, ORLANDO, FL 32804-7012
(407) 843-0041
Mailing address
1800 W COLONIAL DR, ORLANDO, FL 32804-7012
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
FL
Enumeration date
12/07/2017
Last updated
12/07/2017
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