Individual
THEADORA WIPF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFTI
Contact information
Practice address
631 S ORCHARD AVE, UKIAH, CA 95482
(707) 467-2010
Mailing address
140 MENDOCINO DR, UKIAH, CA 95482-5315
(707) 472-2922
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
105413
CA
225C00000X
Rehabilitation Counselor
Primary
105413
CA
Other
Enumeration date
09/28/2012
Last updated
07/24/2018
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