Provider Demographics
NPI:1023578291
Name:DR. WILLOUGHBY AND ASSOCIATES
Entity type:Organization
Organization Name:DR. WILLOUGHBY AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:410-205-9202
Mailing Address - Street 1:10433B STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-0602
Mailing Address - Country:US
Mailing Address - Phone:410-205-9202
Mailing Address - Fax:
Practice Address - Street 1:10433B STEVENSON RD
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:MD
Practice Address - Zip Code:21153-0602
Practice Address - Country:US
Practice Address - Phone:410-205-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty