Individual
ANTHONY K WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
1709 BELMAR DR, GASTONIA, NC 28052-5119
(910) 391-0608
Mailing address
1709 BELMAR DR, GASTONIA, NC 28052-5119
(910) 391-0608
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
2024-12086-01
NC
405300000X
Prevention Professional
Primary
2024-12086-01
NC
Other
Enumeration date
11/14/2024
Last updated
02/16/2026
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