Provider Demographics
NPI:1811558307
Name:WOLFE, CHARLES (MA, CAADC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MA, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 WOOD LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-4250
Mailing Address - Country:US
Mailing Address - Phone:267-358-5150
Mailing Address - Fax:267-298-5901
Practice Address - Street 1:1262 WOOD LN STE 102
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-4250
Practice Address - Country:US
Practice Address - Phone:267-358-5150
Practice Address - Fax:267-298-5901
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13896101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13896OtherPENNSYLVANIA CERTIFICATION BOARD