Provider Demographics
NPI:1063611838
Name:WILLS, DELLA EDWARDS (LCSW)
Entity type:Individual
Prefix:MS
First Name:DELLA
Middle Name:EDWARDS
Last Name:WILLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29205
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71149
Mailing Address - Country:US
Mailing Address - Phone:318-635-9348
Mailing Address - Fax:318-635-9348
Practice Address - Street 1:4615 MONKHOUSE DRIVE
Practice Address - Street 2:STE A-2-B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109
Practice Address - Country:US
Practice Address - Phone:318-773-4505
Practice Address - Fax:318-635-9348
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2512104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker