Basic Information
| Provider Information | |||||||||
| NPI: | 1104969807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | STEWART | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9002 BREVET LN | ||||||||
| Address2: | |||||||||
| City: | MECHANICSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231166591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045691414 | ||||||||
| FaxNumber: | 8045691414 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 JACKSON | ||||||||
| Address2: | RAPPAHANNOCK AREA COMMUNITY SERVICES BOARD | ||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | 5403713753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0701001683 | VA | X | Behavioral Health & Social Service Providers | Counselor | 251S00000X | 0701001683 | VA | X | Agencies | Community/Behavioral Health |
No ID Information.