Healthcare Provider Details

I. General information

NPI: 1962918987
Provider Name (Legal Business Name): WHITNEY FOLSOM-LECOUFFE LICDC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 CAREYS RUN POND CREEK RD
MC DERMOTT OH
45652-3902
US

IV. Provider business mailing address

PO BOX 402
WHEELERSBURG OH
45694-0402
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6683
  • Fax:
Mailing address:
  • Phone: 740-858-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404868
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number162438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: