Provider Demographics
NPI:1235574674
Name:WOLFF, CHRISTIAN (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 NW KEARNEY ST
Mailing Address - Street 2:#403
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2303 N RANDOLPH AVE
Practice Address - Street 2:#5
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1713
Practice Address - Country:US
Practice Address - Phone:503-381-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical