Provider Demographics
NPI:1568120095
Name:WILLOUGHBY, ANITA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:ANN
Last Name:WILLOUGHBY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 COLISEUM DR STE 315
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6257
Mailing Address - Country:US
Mailing Address - Phone:757-736-2500
Mailing Address - Fax:757-227-4713
Practice Address - Street 1:4001 COLISEUM DR STE 315
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6257
Practice Address - Country:US
Practice Address - Phone:757-736-2500
Practice Address - Fax:757-227-4713
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040115041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical