Provider Demographics
NPI:1295208866
Name:WOLLITZ, WILLIAM C
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:WOLLITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CREIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1635
Mailing Address - Country:US
Mailing Address - Phone:775-815-3762
Mailing Address - Fax:
Practice Address - Street 1:10038 MEADOW WAY UNIT A
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4974
Practice Address - Country:US
Practice Address - Phone:530-426-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health