Provider Demographics
NPI:1588378210
Name:WOLCOTT, KATHERINE (MA, CADC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:WOLCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CADC
Mailing Address - Street 1:14015 N 94TH ST APT 2023
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 N MESA DR STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5974
Practice Address - Country:US
Practice Address - Phone:480-590-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI33720821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)