Provider Demographics
NPI:1770709040
Name:WOLSTENCROFT, JOSEPH MICHAEL (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:WOLSTENCROFT
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 INGLESIDE AVE
Mailing Address - Street 2:C-103
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2089
Mailing Address - Country:US
Mailing Address - Phone:478-746-5800
Mailing Address - Fax:
Practice Address - Street 1:2484 INGLESIDE AVE
Practice Address - Street 2:C-103
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2089
Practice Address - Country:US
Practice Address - Phone:478-746-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1545101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist