Provider Demographics
NPI:1578881298
Name:WOFFORD, VICKY DIANE (MA)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:DIANE
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 SUNSET AVE # A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-3522
Mailing Address - Country:US
Mailing Address - Phone:719-424-5928
Mailing Address - Fax:
Practice Address - Street 1:6011 SUNSET AVE # A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-3522
Practice Address - Country:US
Practice Address - Phone:719-424-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20074101YP2500X
COLPC0012024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional