Individual
CLINTON DAVID WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC II
Contact information
Practice address
109 NW MANZANITA AVE, GRANTS PASS, OR 97526
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
931200332
—
OR
Enumeration date
05/11/2017
Last updated
08/09/2022
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