Individual
JONATHAN R WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2900 LOUISIANA BLVD NE STE H, ALBUQUERQUE, NM 87110-3565
(505) 459-1260
Mailing address
1800 GEORGIA ST NE, ALBUQUERQUE, NM 87110-5903
(505) 459-1260
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C-10912
NM
1041C0700X
Clinical Social Worker
C-10912
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55829848
—
NM
Enumeration date
08/22/2017
Last updated
11/29/2024
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