Roger F Willis III, MA, OPT, SUD

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

4343 Williamsbourgh Dr
Sacramento, CA 95823-2006

Phone

(916) 395-3552

NPI assigned

Jan 4, 2019

Sex

Male

Sole proprietor

Yes

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

Credentials

Master of Arts

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570492800000",
    "number": "1770056491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7190 CALVINE RD APT 22",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958235720",
            "telephone_number": "916-459-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 WILLIAMSBOURGH DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232006",
            "telephone_number": "916-395-3552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10157 La Alegria Dr",
            "address_purpose": "LOCATION",
            "city": "Rancho Cordova",
            "state": "CA",
            "postal_code": "956703109",
            "country_code": "US",
            "telephone_number": "916-364-2833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7190 Calvine Rd Apt 22",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958235720",
            "country_code": "US",
            "telephone_number": "916-459-8001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "ROGER",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MA, OPT, SUD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jada Nicole Willis
• James Henry Willis, PH.D
• Jeffrey Ryuta Willis, M.D., PHD
• Lindsay Willis
• Madison Grace Willis
• Sandra E Willis, MD
• Shawnna-Michaella Willis
• Susan Diane Willis, MA
• Wanda F. Willis
• Wendy Willis

• Addiction (Substance Use Disorder) Counselor in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.