Provider Demographics
NPI:1316732266
Name:WILLINGHAM, BRIAN KENDALL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENDALL
Last Name:WILLINGHAM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1884 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-4552
Mailing Address - Country:US
Mailing Address - Phone:810-513-1407
Mailing Address - Fax:
Practice Address - Street 1:1884 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4552
Practice Address - Country:US
Practice Address - Phone:810-513-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI99-4214068101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral