Provider Demographics
NPI:1245388479
Name:WOHLHUETER, MARY JUDITH (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JUDITH
Last Name:WOHLHUETER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:M.
Other - Middle Name:JUDITH
Other - Last Name:WOHLHUETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:530 OAKDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1606
Mailing Address - Country:US
Mailing Address - Phone:404-230-9796
Mailing Address - Fax:
Practice Address - Street 1:4530 S BERKELEY LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1660
Practice Address - Country:US
Practice Address - Phone:404-230-9796
Practice Address - Fax:770-446-5643
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC# 001340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional