Provider Demographics
NPI:1821632142
Name:VALERIE WOOLFORD INDIVIDUAL & COUPLES COUNSELING, LLC
Entity Type:Organization
Organization Name:VALERIE WOOLFORD INDIVIDUAL & COUPLES COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-889-2519
Mailing Address - Street 1:PO BOX 54065
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-4065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 THE LAKES BLVD STE G3
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5667
Practice Address - Country:US
Practice Address - Phone:856-889-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health