Provider Demographics
NPI:1215294541
Name:WOLD, CARMELLA A (MSW)
Entity type:Individual
Prefix:MRS
First Name:CARMELLA
Middle Name:A
Last Name:WOLD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-9999
Mailing Address - Country:US
Mailing Address - Phone:269-926-6199
Mailing Address - Fax:269-926-6780
Practice Address - Street 1:1850 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9999
Practice Address - Country:US
Practice Address - Phone:269-926-6199
Practice Address - Fax:269-926-6780
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health