Destenie Willis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW008831 Issued in GA

Practice address

1909 Columbia Dr
Decatur, GA 30032-5912

Phone

(404) 345-2537

NPI assigned

Sep 5, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Destenie Ray Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1725494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1902631179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 COLUMBIA DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300325912",
            "telephone_number": "404-345-2537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 COLUMBIA DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300325912",
            "telephone_number": "404-345-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DESTENIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-05",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "5534C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW008831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESTENIE",
            "last_name": "RAY",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ellen Gena Williamson, MSW
• La'Sherraneta Williamson, LPC
• Meredith Williamson, PSY.D.
• Sarah Ann Stevenson Williford, OD
• Ashley Willis, DPM
• Jessica Willis, FNP-C
• Kayla Channel Willis
• Laneatria Lynn Willis, CPHT, CHES
• Lynyetta G Willis, PHD
• Rachel Helen Willis, LPC

• Clinical Social Worker in Decatur, GA
• Providers in Decatur, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.