Provider Demographics
NPI:1780407627
Name:WILLOUGHBY, JENNIFER RENEE (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MCGHEE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-4508
Mailing Address - Country:US
Mailing Address - Phone:615-636-3358
Mailing Address - Fax:
Practice Address - Street 1:115 FAIRBANKS RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7052
Practice Address - Country:US
Practice Address - Phone:865-482-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000014869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker