Provider Demographics
NPI:1104468396
Name:WOLFE, JASMINE MARIE (CDCA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 SANDHILL RD LOT 10
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-8779
Mailing Address - Country:US
Mailing Address - Phone:740-236-8681
Mailing Address - Fax:
Practice Address - Street 1:1417 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-7973
Practice Address - Country:US
Practice Address - Phone:740-236-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.171046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty