Provider Demographics
NPI:1902678337
Name:WILLOUGHBY, KENYA
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 VAN EATON LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5147
Mailing Address - Country:US
Mailing Address - Phone:901-833-2967
Mailing Address - Fax:
Practice Address - Street 1:2524 VAN EATON LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-5147
Practice Address - Country:US
Practice Address - Phone:901-833-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool