Provider Demographics
NPI:1902205131
Name:WOFFORD, JOSEPH RUFUS (MA, LPC, NCC, CCMHC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RUFUS
Last Name:WOFFORD
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-753-5591
Practice Address - Street 1:8063 EDMUND HWY
Practice Address - Street 2:
Practice Address - City:PELION
Practice Address - State:SC
Practice Address - Zip Code:29123-9805
Practice Address - Country:US
Practice Address - Phone:803-894-3736
Practice Address - Fax:803-894-5315
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007517101YP2500X
SC5462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1410Medicaid