Provider Demographics
NPI:1912399379
Name:WILLOW, CORA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:WILLOW
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WEAVER BLVD STE 234
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8345
Mailing Address - Country:US
Mailing Address - Phone:919-259-1896
Mailing Address - Fax:
Practice Address - Street 1:220 PINK FOX COVE RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8813
Practice Address - Country:US
Practice Address - Phone:919-259-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC00090571041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical