Provider Demographics
NPI:1700228467
Name:WOLF, CHRISTINA DENISE (LMHCA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DENISE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0996
Mailing Address - Country:US
Mailing Address - Phone:360-376-7545
Mailing Address - Fax:
Practice Address - Street 1:461 DISCOVERY WAY
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-2211
Practice Address - Country:US
Practice Address - Phone:360-376-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60275956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health