Provider Demographics
NPI:1124490776
Name:WILLIS, ASHLEY ALICIA (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ALICIA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4779 CLAIRELEE DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4759
Mailing Address - Country:US
Mailing Address - Phone:443-386-4897
Mailing Address - Fax:
Practice Address - Street 1:100 OWINGS CT STE 12
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6434
Practice Address - Country:US
Practice Address - Phone:443-386-4897
Practice Address - Fax:443-640-4358
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD179881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical