Provider Demographics
NPI:1992578454
Name:WOLFE, CARLA S
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MCCARTY LN STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-7025
Mailing Address - Country:US
Mailing Address - Phone:740-577-9003
Mailing Address - Fax:740-577-9184
Practice Address - Street 1:502 MCCARTY LN STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-7025
Practice Address - Country:US
Practice Address - Phone:740-577-9003
Practice Address - Fax:740-577-9184
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health