Susan Elizabeth Willis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1370 Issued in NC

Practice address

1066 W 4TH St
Winston-Salem, NC 27101-2434

Phone

(336) 723-3155

Fax

(336) 734-1188

NPI assigned

May 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1689627945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1066 W 4TH ST",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271012434",
            "telephone_number": "336-723-3155",
            "fax_number": "336-734-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 W 4TH ST",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271012434",
            "telephone_number": "336-723-3155",
            "fax_number": "336-734-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SUSAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0490C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "281962",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL SERVICE",
            "identifier": "14751863",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Cauthen Willingham, MD
• Allison Louise Willis, RD
• Anne Linn Willis, M.D.
• Jamison Willis, DO
• John Harter Willis, MD
• Meghan Elizabeth Willoughby
• Christy Craven Willson, NP
• Jackie Wilmoth
• Jennifer Elaine Wilmoth, P.A.
• Stephanie Wilson Davis, RN, MSN

• Clinical Psychologist in Winston-Salem, NC
• Providers in Winston-Salem, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.