Provider Demographics
NPI:1528277373
Name:WOLF, VICTORIA (CATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MILLER ST
Mailing Address - Street 2:SUITE 101 & 102
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5233
Mailing Address - Country:US
Mailing Address - Phone:805-925-9811
Mailing Address - Fax:805-925-9706
Practice Address - Street 1:201 S MILLER ST
Practice Address - Street 2:SUITE 101 & 102
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5233
Practice Address - Country:US
Practice Address - Phone:805-925-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)