Provider Demographics
NPI:1962560417
Name:WOFFORD-GILMORE, BETINA R (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:BETINA
Middle Name:R
Last Name:WOFFORD-GILMORE
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:MRS
Other - First Name:BETINA
Other - Middle Name:R
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSW,LCSW
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-1272
Mailing Address - Country:US
Mailing Address - Phone:951-305-1725
Mailing Address - Fax:
Practice Address - Street 1:41765 RIDER WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4826
Practice Address - Country:US
Practice Address - Phone:951-305-1725
Practice Address - Fax:951-262-8163
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical