Individual
MONDERRICK WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
394 BROADWAY FL 4, NEW YORK, NY 10013-6023
(718) 516-6007
(212) 584-5450
Mailing address
394 BROADWAY FL 4, NEW YORK, NY 10013-6023
(718) 514-6007
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
39117
NY
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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