Provider Demographics
NPI:1710917695
Name:WOLF, VANINA A (LAC, DIPLAC)
Entity Type:Individual
Prefix:MRS
First Name:VANINA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E JOPPA RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3150
Mailing Address - Country:US
Mailing Address - Phone:443-519-5128
Mailing Address - Fax:
Practice Address - Street 1:200 E JOPPA RD
Practice Address - Street 2:SUITE 108
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3150
Practice Address - Country:US
Practice Address - Phone:443-519-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist