Individual
LAWRENCE CARLSON WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
403 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 533-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002033A
IN
Other
Enumeration date
02/28/2006
Last updated
09/28/2010
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