Kent, David Willis

Kent, David Willis is an individual health care provider with primary practice located at 930 Alicea Rd , Lakeland FL 33810. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Kent, David Willis can be contacted via phone (863) 680-1950.

Contact Information

Primary practice address
930 Alicea Rd Lakeland FL 33810
Phone: (863) 680-1950
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CAP3269 Florida
Behavioral Health & Social Service Providers / Clinical 1041C0700X SW5054 Florida

Profile Details

NPI number 1407892656
LBN Legal business name Kent, David Willis
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Oct 29th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407892656 NPPES
Florida MEDICAID 762848000

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