Provider Demographics
NPI:1609035575
Name:WILLARD, VIVIAN JOY (MED)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:JOY
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 N MCLAURIN LANE
Mailing Address - Street 2:BALLENTINE ELEMENTARY SCHOOL
Mailing Address - City:FUQUAY-VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5345
Mailing Address - Country:US
Mailing Address - Phone:919-557-1127
Mailing Address - Fax:919-557-1144
Practice Address - Street 1:1651 N MCLAURIN LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5345
Practice Address - Country:US
Practice Address - Phone:919-557-1127
Practice Address - Fax:919-557-1144
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC598101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool