Benjamin Sheppard Willis, LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P015847 Issued in NC

Practice address

3608 University Dr Ste 101
Durham, NC 27707-6260

Phone

(919) 433-0170

Fax

(919) 226-0026

NPI assigned

Jun 16, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Easter Seals Ucp North Carolina & Virginia, Inc.

  • Pharmacy
  • New Bern, NC
  • NPI 1013769629
  NPD (past)
• Easter Seals Ucp North Carolina & Virginia, Inc.

  • Community/Behavioral Health Agency
  • Durham, NC
  • NPI 1568524031
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1184354672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 UNIVERSITY DR STE 101",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277076260",
            "telephone_number": "919-433-0170",
            "fax_number": "919-226-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 UNIVERSITY DR STE 101",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277076260",
            "telephone_number": "919-433-0170",
            "fax_number": "919-226-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "BENJAMIN",
        "middle_name": "SHEPPARD",
        "credential": "LCSW-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-16",
        "last_updated": "2022-06-16",
        "certification_date": "2022-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P015847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louise Margaret Williamson
• Cinthia M. Williford, DPT
• Margaret Williford, M.D.
• Alecia Willis, PH.D.
• Amique Amoy Willis
• Charles Steadman Willis III, D.M.D.
• Charles Steadman Willis, DDS
• Christine Willis
• David Dawson Willis, MD
• Faith Noelle Willis, LCSW

• Clinical Social Worker in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.