Provider Demographics
NPI:1285088260
Name:WILLIS, KERI RENEE (MA, NCC, LCMHC)
Entity type:Individual
Prefix:MS
First Name:KERI
Middle Name:RENEE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 HAYWOOD RD STE J
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-7111
Mailing Address - Country:US
Mailing Address - Phone:828-412-0890
Mailing Address - Fax:828-392-8001
Practice Address - Street 1:775 HAYWOOD RD STE J
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-7111
Practice Address - Country:US
Practice Address - Phone:828-412-0890
Practice Address - Fax:828-392-8001
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16243101YP2500X, 261QM0850X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health