Provider Demographics
NPI:1972277143
Name:WILLIFORD, AUTUMN RAE
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:RAE
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-493 AHUIMANU RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4883
Mailing Address - Country:US
Mailing Address - Phone:808-940-6585
Mailing Address - Fax:
Practice Address - Street 1:47-493 AHUIMANU RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4883
Practice Address - Country:US
Practice Address - Phone:808-940-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician