Provider Demographics
NPI:1992257505
Name:WOLOS, GEORGE (MDIV)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:WOLOS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1721
Mailing Address - Country:US
Mailing Address - Phone:609-287-2747
Mailing Address - Fax:609-380-7428
Practice Address - Street 1:5918 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1721
Practice Address - Country:US
Practice Address - Phone:609-287-2747
Practice Address - Fax:609-380-7428
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00052800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)