Healthcare Provider Details

I. General information

NPI: 1790583235
Provider Name (Legal Business Name): AUTUMN WOHLFORD LPC, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 MCLAWS CIR
WILLIAMSBURG VA
23185-5636
US

IV. Provider business mailing address

PO BOX 24
WHITE MARSH VA
23183-0024
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-3860
  • Fax:
Mailing address:
  • Phone: 804-792-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014575
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: