Provider Demographics
NPI:1508173576
Name:WOLFORD, ETHEL LEARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:LEARY
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-1933
Mailing Address - Country:US
Mailing Address - Phone:252-447-3297
Mailing Address - Fax:
Practice Address - Street 1:213 WEBB BLVD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-1933
Practice Address - Country:US
Practice Address - Phone:252-447-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical