Basic Information
| Provider Information | |||||||||
| NPI: | 1508231671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | KAZANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2515 CANAL ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048220888 | ||||||||
| FaxNumber: | 5048220831 | ||||||||
| Practice Location | |||||||||
| Address1: | 2515 CANAL ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048220888 | ||||||||
| FaxNumber: | 5048220831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2015 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5054 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 172V00000X | 5054 | LA | N | Other Service Providers | Community Health Worker |
No ID Information.