Provider Demographics
NPI:1649783499
Name:WOHLFORD, THEODORE J (LPC, LMFT, NCC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:J
Last Name:WOHLFORD
Suffix:
Gender:M
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BRIDGE ST NW STE 1120
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5356
Mailing Address - Country:US
Mailing Address - Phone:616-805-3660
Mailing Address - Fax:616-805-3631
Practice Address - Street 1:118 S GREENVILLE WEST DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3554
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:616-805-3631
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014910101Y00000X, 101YP2500X
MI4101006847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist