Provider Demographics
NPI:1407865678
Name:WILLIFORD, NANCY E (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2107
Mailing Address - Country:US
Mailing Address - Phone:619-702-8833
Mailing Address - Fax:619-232-9923
Practice Address - Street 1:4452 PARK BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4051
Practice Address - Country:US
Practice Address - Phone:619-294-3500
Practice Address - Fax:619-232-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 215711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ22396Medicare UPIN