Provider Demographics
NPI:1508567967
Name:WILLOUGHBY-ROBERTS, DAWNA RENEE
Entity Type:Individual
Prefix:MS
First Name:DAWNA
Middle Name:RENEE
Last Name:WILLOUGHBY-ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CLUB RD STE 310
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2420
Mailing Address - Country:US
Mailing Address - Phone:541-517-9137
Mailing Address - Fax:
Practice Address - Street 1:2145 ROCKY LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7431
Practice Address - Country:US
Practice Address - Phone:541-517-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7907101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health