Provider Demographics
NPI:1871788612
Name:WILLOUGHBY, CRYSTAL MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MARIE
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10433B STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21153-0602
Mailing Address - Country:US
Mailing Address - Phone:410-205-9202
Mailing Address - Fax:
Practice Address - Street 1:10433B STEVENSON RD
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:MD
Practice Address - Zip Code:21153-0602
Practice Address - Country:US
Practice Address - Phone:410-205-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical