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General NPI Number Information
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NPI Number | 1558423608
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Entity Type | Individual
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Provider Name | MARY A. WILLINGHAM LPC
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 315 E WASHINGTON ST
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City | GREENSBORO
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State | NC
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Zip | 27401-2911
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Country | US
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Telephone | 336-387-6161
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Fax | 336-387-9167
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Provider Business Mailing Address
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Address Line | 902 BONNER DR
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City | JAMESTOWN
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State | NC
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Zip | 27282-8948
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Country | US
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Telephone | 336-889-6105
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Fax | 336-384-9167
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2119
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License Number State | NC
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