MS. MARY WILLIS (NPI# 1083700652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083700652 |
| Entity Type | Individual |
| Full Name | MS. MARY WILLIS |
| Credential | LPC |
| Practice Address |
4656 Brambleton Avenue Roanoke VA 24018 |
| Mailing Address |
755 Independence Blvd Christiansburg VA 24073 |
| Practice Telephone | 5407728043 |
| Practice Fax Number | 5407728242 |
| Mailing Telephone | 5403920711 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
0701003372 | VA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | SOUTHERN HEALTH | 087515M | 01 |
| VA | ANTHEM BCBS | 191801 | 01 |
| TX | AETNA | 7684485 | 01 |
| VA | VALUE OPTIONS | 488754 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677406 | Mary Grace Willis | Licensed Vocational Nurse | 232 County Road 2921, Alba, TX 75410-5830 | 2020-10-22 |
| 1477051449 | Mary E Willis | Nurse Practitioner | 10510 Jefferson Ave Ste E, Newport News, VA 23601-3102 | 2018-01-25 |
| 1417313263 | Mary Willis | Physical Therapy Assistant | 10077 Infinity Ln, Piqua, OH 45356-7512 | 2016-01-10 |
| 1700185964 | Mary Miranda Willis | Licensed Practical Nurse | 303 Rellim Dr, Kent, OH 44240-4531 | 2011-03-26 |
| 1518504620 | Mary Judith Willis | Counselor | 3333 University Ave Se, Minneapolis, MN 55414-3325 | 2019-12-08 |
| 1831521269 | Mary Willis | Pharmacist | 3800 Se 22nd Ave, 04004/rds, Portland, OR 97202-2918 | 2013-08-08 |
| 1083992267 | Mary Kristine Willis | Physician Assistant | 1935 Medical District Dr, Dallas, TX 75235-7701 | 2011-07-22 |
| 1811223324 | Mary Kay Willis | Specialist/Technologist | 1248 Austin Hwy, Suite 210, San Antonio, TX 78209-4821 | 2009-10-19 |
| 1710127626 | Mary E Willis | Dietitian, Registered | 15101 Glenwood Ave, Stanley, KS 66223-3154 | 2009-03-05 |
| 1346499241 | Mary E Willis | Clinic/Center | 550 Pope Ave, Fort Leavenworth, KS 66027-2332 | 2008-09-16 |
| Street Address |
4656 BRAMBLETON AVENUE |
| City | ROANOKE |
| State | VA |
| Zip Code | 24018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140253 | Luz Dione Carr | Nurse Practitioner | 1934 Maple Leaf Drive, Roanoke, VA 24018 | 2019-05-21 |
| 1467926527 | Embrace Foster Care, LLC | Foster Care Agency | 3912 Electric Road, Building C, Roanoke, VA 24018 | 2019-01-11 |
| 1174005417 | Roanoke Valley Ent & Allergy PC | Otolaryngology | 2154 Mcvitty Rd, Second Floor, Roanoke, VA 24018 | 2018-09-04 |
| 1265928535 | Jane Willis Warner | Behavior Technician | 3243 Electric Road Building E Suite 1b, Roanoke, VA 24018 | 2018-07-10 |
| 1821584640 | Anchor To Hope Counseling LLC | Counselor | 4370 Starkey Rd Ste 4c-1, Roanoke, VA 24018 | 2018-07-04 |
| 1164938619 | Aurora Domangue | Behavior Technician | 3243 Electric Road, Building E Suite 1b, Roanoke, VA 24018 | 2017-12-20 |
| 1376059089 | Maggie Marie Ridgeway | Behavior Technician | 3243 Electric Rd., Building E Suite 1b, Roanoke, VA 24018 | 2017-12-18 |
| 1700301850 | Nicole Graboski | Speech-Language Pathologist | 4920 Woodmar Drive Sw, Roanoke, VA 24018 | 2017-08-10 |
| 1891215893 | Kimberly Anne Rosenberger | Occupational Therapy Assistant | 2772 Hillbrook Dr., Roanoke, VA 24018 | 2017-06-21 |
| 1083158950 | Encompass Home Health of Roanoke, LLC | Home Health | 5115 Bernard Drive, Suite 205, Roanoke, VA 24018 | 2016-12-13 |
| Find all providers in zip 24018 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872021 | Insights & Inspiration, LLC | Counselor | 6235 Buckland Mill Rd, Roanoke, VA 24019-6709 | 2020-08-17 |
| 1689283525 | Lea Ann Crawford | Counselor | 1401 Pine Ridge Rd, Roanoke, TX 76262-6444 | 2020-07-27 |
| 1972129435 | Abrina Marie Schnurman-crook | Counselor | 2022 Maiden Ln Sw, Roanoke, VA 24015-2310 | 2020-06-21 |
| 1669095410 | Kaisha Williams | Counselor | 6870 Woodcreeper Dr, Roanoke, VA 24019-3816 | 2020-05-27 |
| 1003439043 | Mary Francis | Counselor | 175 Summit Way Sw, Roanoke, VA 24014-5156 | 2020-05-26 |
| 1720618804 | Angela Dee Conway | Counselor | 15476 Yarberry Dr, Roanoke, TX 76262-3351 | 2020-01-17 |
| 1235786997 | Jayna Madeleine Ratliff | Counselor | 3807 Brandon Ave Sw Ste 1115, Roanoke, VA 24018-1490 | 2019-08-19 |
| 1205496353 | Jennie Antonette Sitman | Counselor | 5220 Hazelridge Rd Nw, Roanoke, VA 24012-1542 | 2019-06-19 |
| 1063072312 | Restore Family Counseling, Inc. | Counselor | 3959 Electric Rd Ste 125, Roanoke, VA 24018-4559 | 2019-06-18 |
| 1760949051 | Sabrina M Cowan | Counselor | 3524 Brambleton Ave Ste 6, Roanoke, VA 24018-6528 | 2019-02-22 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.