Provider Demographics
NPI:1275257651
Name:WOLFE, JASON JONAS (LSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JONAS
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PONDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:FISHER
Mailing Address - State:WV
Mailing Address - Zip Code:26818-5600
Mailing Address - Country:US
Mailing Address - Phone:304-851-7845
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9570
Practice Address - Country:US
Practice Address - Phone:304-257-1015
Practice Address - Fax:304-257-1129
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00945052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker