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General NPI Number Information
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NPI Number | 1427626670
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Entity Type | Individual
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Provider Name | DONALD WAYNE WEATHERFORD LPC
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Gender | Male
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4039 GATEWAY BLVD
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City | GROVETOWN
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State | GA
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Zip | 30813-3389
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Country | US
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Telephone | 706-498-9570
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Fax |
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Provider Business Mailing Address
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Address Line | 2135 GA HIGHWAY 171 N
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City | LOUISVILLE
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State | GA
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Zip | 30434-3920
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Country | US
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Telephone | 478-217-2916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 013590
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License Number State | GA
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