Provider Demographics
NPI:1023198413
Name:WOLFE, JIM (JAMES) (MFT)
Entity Type:Individual
Prefix:
First Name:JIM (JAMES)
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-6577
Mailing Address - Country:US
Mailing Address - Phone:925-323-4113
Mailing Address - Fax:508-445-8292
Practice Address - Street 1:2930 CAMINO DIABLO
Practice Address - Street 2:SUITE #200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3986
Practice Address - Country:US
Practice Address - Phone:925-323-4113
Practice Address - Fax:508-445-8292
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32199106H00000X
IDLMFT2783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist