Provider Demographics
NPI:1114179199
Name:WOLF, DIANA (PCC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PCC
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 1098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1098
Mailing Address - Country:US
Mailing Address - Phone:330-798-0491
Mailing Address - Fax:330-303-4948
Practice Address - Street 1:3768 BOARDMAN CANFIELD RD STE 5
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8502
Practice Address - Country:US
Practice Address - Phone:330-798-0491
Practice Address - Fax:330-303-4948
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500502-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional