Provider Demographics
NPI:1083954895
Name:WILLOUGHBY, CAROL J (CAROL WILLOUGHBY)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:CAROL WILLOUGHBY
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:J
Other - Last Name:WILLOUGHBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAROL WILLOUGHBY,MED
Mailing Address - Street 1:656 S QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6309
Mailing Address - Country:US
Mailing Address - Phone:402-270-3195
Mailing Address - Fax:
Practice Address - Street 1:2363 18TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2601
Practice Address - Country:US
Practice Address - Phone:402-270-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health