Provider Demographics
NPI:1851151195
Name:WILLOW RIVER BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:WILLOW RIVER BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-721-0418
Mailing Address - Street 1:113 TOPPIN CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-1020
Mailing Address - Country:US
Mailing Address - Phone:919-721-0418
Mailing Address - Fax:
Practice Address - Street 1:113 TOPPIN CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-1020
Practice Address - Country:US
Practice Address - Phone:919-721-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health