Provider Demographics
NPI:1083148621
Name:WILLOUGHBY, ASHLEY (LPCA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0168
Mailing Address - Country:US
Mailing Address - Phone:910-843-1997
Mailing Address - Fax:910-843-2171
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377
Practice Address - Country:US
Practice Address - Phone:910-843-1997
Practice Address - Fax:910-843-2171
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC755663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health