Individual
MR. GERALD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
F.S.A.C.
Contact information
Practice address
13220 WOODWARD AVE, HIGHLAND PARK, MI 48203-3610
(313) 852-1637
Mailing address
13220 WOODWARD AVE, HIGHLAND PARK, MI 48203-3610
(313) 852-1637
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740313238
CHRISTIAN GUIDANCE CENTER
MI
05
—
3022440
—
MI
Enumeration date
03/23/2007
Last updated
07/26/2007
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