Provider Demographics
NPI:1235623398
Name:WILLOUGHBY, AVRIL MICHELE (CPRS)
Entity Type:Individual
Prefix:MS
First Name:AVRIL
Middle Name:MICHELE
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21990 RIVER OAKS DR APT 28
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3121
Mailing Address - Country:US
Mailing Address - Phone:440-258-6368
Mailing Address - Fax:
Practice Address - Street 1:21990 RIVER OAKS DR APT 28
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3121
Practice Address - Country:US
Practice Address - Phone:440-258-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00689175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist