Provider Demographics
NPI:1891855979
Name:KEELER-WOLF, VIRGINIA ANN (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANN
Last Name:KEELER-WOLF
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LEIMERT BLVD
Mailing Address - Street 2:STE. 302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1808
Mailing Address - Country:US
Mailing Address - Phone:510-339-9363
Mailing Address - Fax:510-531-3394
Practice Address - Street 1:1425 LEIMERT BLVD
Practice Address - Street 2:STE. 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1808
Practice Address - Country:US
Practice Address - Phone:510-339-9363
Practice Address - Fax:510-531-3394
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist