Provider Demographics
NPI:1619981974
Name:WOLTER, CHARLOTTE ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:WOLTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 QUAIL CT
Mailing Address - Street 2:110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5547
Mailing Address - Country:US
Mailing Address - Phone:925-937-7924
Mailing Address - Fax:925-937-7690
Practice Address - Street 1:45 QUAIL CT
Practice Address - Street 2:110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5547
Practice Address - Country:US
Practice Address - Phone:925-937-7924
Practice Address - Fax:925-937-7690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC31284OtherMARRIAGE FAMILY THERAPIST