Provider Demographics
NPI:1144309295
Name:WILLS, DOROTHY (RN-BC, MAC, LPC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:RN-BC, MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3274
Mailing Address - Country:US
Mailing Address - Phone:256-236-2246
Mailing Address - Fax:256-237-2246
Practice Address - Street 1:2104 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3274
Practice Address - Country:US
Practice Address - Phone:256-236-2246
Practice Address - Fax:256-237-2246
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2630101YP2500X
MO2001031970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional