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Individual

DR. SUSAN ELIZABETH WILLIS

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
1066 W 4TH ST, WINSTON-SALEM, NC 27101-2434
(336) 723-3155
(336) 734-1188
Mailing address
1066 W 4TH ST, WINSTON-SALEM, NC 27101-2434
(336) 723-3155
(336) 734-1188

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1370
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0490C
BCBS
NC
01
14751863
UNITED BEHAVIORAL SERVICE
NC
01
281962
VALUEOPTIONS
NC
Enumeration date
05/18/2006
Last updated
07/08/2007
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