Provider Demographics
NPI:1447981006
Name:WILLARD, CARLY ROSE (APCC)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:ROSE
Last Name:WILLARD
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 E ALOSTA AVE # 344
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2740
Mailing Address - Country:US
Mailing Address - Phone:909-378-5894
Mailing Address - Fax:
Practice Address - Street 1:2788 EAST BERRY PRIVADO
Practice Address - Street 2:UNIT 90
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2740
Practice Address - Country:US
Practice Address - Phone:909-378-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health