Provider Demographics
NPI:1508157595
Name:WOLF CREEK ACADEMY
Entity Type:Organization
Organization Name:WOLF CREEK ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRES./EXEC. DIR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD NAFC 24375
Authorized Official - Phone:828-680-9173
Mailing Address - Street 1:P.O BOX 2001
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754
Mailing Address - Country:US
Mailing Address - Phone:828-680-9173
Mailing Address - Fax:828-689-5921
Practice Address - Street 1:41 BEAUTY SPOT COVE RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754
Practice Address - Country:US
Practice Address - Phone:828-680-9173
Practice Address - Fax:828-689-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty