Provider Demographics
NPI:1710168356
Name:WILLIFORD, ROXANNE KAYE (MC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:KAYE
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17667 N 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3019
Mailing Address - Country:US
Mailing Address - Phone:623-385-3590
Mailing Address - Fax:623-385-3599
Practice Address - Street 1:17667 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3019
Practice Address - Country:US
Practice Address - Phone:623-385-3590
Practice Address - Fax:623-385-3599
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional