Individual
BREONNA SHANICE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
482 S KELLER RD, ORLANDO, FL 32810-6130
(689) 204-3341
Mailing address
482 S KELLER RD, ORLANDO, FL 32810-6130
(689) 204-3341
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62395
CHILDREN'S HOME SOCIETY
FL
Enumeration date
12/04/2020
Last updated
12/04/2020
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