Provider Demographics
NPI:1104865773
Name:WHOLEY, JOANNE M (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:WHOLEY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOUNTAIN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2343
Mailing Address - Country:US
Mailing Address - Phone:860-836-5125
Mailing Address - Fax:860-243-8488
Practice Address - Street 1:11 MOUNTAIN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2343
Practice Address - Country:US
Practice Address - Phone:860-836-5125
Practice Address - Fax:860-243-8488
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional