Provider Demographics
NPI:1043736952
Name:WILLIS, WHITNEY LAYNE (MSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LAYNE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3357
Mailing Address - Country:US
Mailing Address - Phone:541-870-7638
Mailing Address - Fax:
Practice Address - Street 1:7364 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1864
Practice Address - Country:US
Practice Address - Phone:619-541-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical