Provider Demographics
NPI:1104969807
Name:WILLIS, JAMES STEWART III (MS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STEWART
Last Name:WILLIS
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N PARHAM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3171
Mailing Address - Country:US
Mailing Address - Phone:804-270-1124
Mailing Address - Fax:
Practice Address - Street 1:2301 N PARHAM RD STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-3171
Practice Address - Country:US
Practice Address - Phone:804-270-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001683101Y00000X, 251S00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health