Provider Demographics
NPI:1811409931
Name:WOLFE, CHRISTINA CAROL (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CAROL
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NEW PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-6436
Mailing Address - Country:US
Mailing Address - Phone:301-667-0374
Mailing Address - Fax:
Practice Address - Street 1:1985 AL HIGHWAY 157 STE B
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1124
Practice Address - Country:US
Practice Address - Phone:256-775-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009443761041C0700X
AL4521C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical