Individual
GARY WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3290 MERIDIAN RD, COLUMBUS, OH 43232-4079
(614) 949-3296
Mailing address
3290 MERIDIAN RD, COLUMBUS, OH 43232-4079
(614) 949-3296
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
172764
OH
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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