Healthcare Provider Details

I. General information

NPI: 1558423608
Provider Name (Legal Business Name): MARY A. WILLINGHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WASHINGTON ST
GREENSBORO NC
27401-2911
US

IV. Provider business mailing address

902 BONNER DR
JAMESTOWN NC
27282-8948
US

V. Phone/Fax

Practice location:
  • Phone: 336-387-6161
  • Fax: 336-387-9167
Mailing address:
  • Phone: 336-889-6105
  • Fax: 336-384-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2119
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: