Provider Demographics
NPI:1619165347
Name:WITHAM, BOBBI JO (MA, NCC, LPC, BC-TMH)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:WITHAM
Suffix:
Gender:F
Credentials:MA, NCC, LPC, BC-TMH
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:JO
Other - Last Name:WENDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LPC
Mailing Address - Street 1:50 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2768
Mailing Address - Country:US
Mailing Address - Phone:724-705-9535
Mailing Address - Fax:
Practice Address - Street 1:50 BERRY RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2768
Practice Address - Country:US
Practice Address - Phone:724-705-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2632101YP2500X
PAPC004566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional