Individual
STEPHANIE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
78 E MAIN ST STE C, BUFORD, GA 30518-5711
(678) 357-3161
Mailing address
969 MILL BEND DR, LAWRENCEVILLE, GA 30044-6146
(678) 230-9822
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
744042
GA
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
GA
Enumeration date
03/08/2022
Last updated
03/03/2026
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