Individual
LOURDES FELISA WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, QMHP, SF
Contact information
Practice address
8180 HAMILTON DR, GLOUCESTER, VA 23061-5296
(804) 824-2300
(804) 824-2300
Mailing address
8180 HAMILTON DR, GLOUCESTER, VA 23061-5296
(804) 824-2300
(804) 824-2300
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
12VAC30-120-730
VA
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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