Provider Demographics
NPI:1710558408
Name:WILLIFORD, DONNA KATHERINE SPRING (LCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KATHERINE SPRING
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WILLIFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHCA
Mailing Address - Street 1:2702 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1705
Mailing Address - Country:US
Mailing Address - Phone:919-685-0517
Mailing Address - Fax:
Practice Address - Street 1:6604 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6521
Practice Address - Country:US
Practice Address - Phone:984-235-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional