Provider Demographics
NPI:1144934852
Name:WILLIS, XAVIER DIRELL (MA)
Entity type:Individual
Prefix:PROF
First Name:XAVIER
Middle Name:DIRELL
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 MAYFIELD RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1633
Mailing Address - Country:US
Mailing Address - Phone:216-645-8677
Mailing Address - Fax:
Practice Address - Street 1:2867 MAYFIELD RD APT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1633
Practice Address - Country:US
Practice Address - Phone:216-645-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist