Provider Demographics
NPI:1699704163
Name:WILLIS, SHEILA G (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:G
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:SHEILA
Other - Middle Name:G
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:647 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3951
Mailing Address - Country:US
Mailing Address - Phone:404-423-3168
Mailing Address - Fax:
Practice Address - Street 1:647 PARKER AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3951
Practice Address - Country:US
Practice Address - Phone:404-423-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker