Provider Demographics
NPI:1588176838
Name:WILLIS, LEONA (LCPC, LPC)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:LEONA
Other - Middle Name:
Other - Last Name:BRANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3738 CASTLE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4702
Mailing Address - Country:US
Mailing Address - Phone:202-747-8973
Mailing Address - Fax:
Practice Address - Street 1:1300 L ST NW STE 1030
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4107
Practice Address - Country:US
Practice Address - Phone:202-597-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional