Provider Demographics
NPI:1679633424
Name:WACHTER, THEODORE JEFFREY (PH D, LPC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JEFFREY
Last Name:WACHTER
Suffix:
Gender:M
Credentials:PH D, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 DUNCAN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205
Mailing Address - Country:US
Mailing Address - Phone:803-252-9272
Mailing Address - Fax:803-929-3849
Practice Address - Street 1:2717 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2519
Practice Address - Country:US
Practice Address - Phone:803-252-9272
Practice Address - Fax:803-929-3849
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional