Individual
JENNIFER CHRISTA WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
41900 FENWICK ST, SUITE #1, LEONARDTOWN, MD 20650-3814
(301) 475-9660
(301) 475-8810
Mailing address
PO BOX 1608, LEONARDTOWN, MD 20650-1608
(301) 475-9660
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
03600
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
262293000
MAGELLAN
MD
01
—
379528
MDIPA
MD
01
—
517B 60718903
CAREFIRST BCBS
MD
01
—
7729469
AETNA
MD
01
—
B950 0007
CAREFIRST BCBS FEP & NCA
MD
01
—
PVPB114888
APS
MD
Enumeration date
08/21/2006
Last updated
01/08/2013
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