Individual
MARLON WILLINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6530 DAVIDSON ST APT B3, COLUMBIA, SC 29209-1731
(803) 962-9576
Mailing address
6530 DAVIDSON ST APT B3, COLUMBIA, SC 29209-1731
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3335
MEDICARE
SC
05
—
421504
—
SC
Enumeration date
06/05/2019
Last updated
01/08/2025
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