Provider Demographics
NPI:1063795870
Name:WILL'S WAY, LLC
Entity type:Organization
Organization Name:WILL'S WAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNELL
Authorized Official - Middle Name:SPEIGHTS
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-466-9190
Mailing Address - Street 1:PO BOX 15955
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5955
Mailing Address - Country:US
Mailing Address - Phone:601-466-9190
Mailing Address - Fax:186-662-5055
Practice Address - Street 1:604 ADELINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3842
Practice Address - Country:US
Practice Address - Phone:601-466-9190
Practice Address - Fax:186-662-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS204130103TS0200X
MS47821103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty