Provider Demographics
NPI:1699507426
Name:WILLIS, JUSTIN JAMES (CADC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAMES
Last Name:WILLIS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 MIDDLE RD STE 508
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7905
Mailing Address - Country:US
Mailing Address - Phone:309-716-1536
Mailing Address - Fax:
Practice Address - Street 1:2550 MIDDLE RD STE 508
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7905
Practice Address - Country:US
Practice Address - Phone:309-716-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37222101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health