Provider Demographics
NPI:1861839839
Name:WOFFORD, ALICIA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:WOFFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 ALI DR DEPT 320
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5193
Mailing Address - Country:US
Mailing Address - Phone:810-428-1181
Mailing Address - Fax:
Practice Address - Street 1:5445 ALI DR DEPT 320
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5193
Practice Address - Country:US
Practice Address - Phone:810-428-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1861839839Medicaid