Provider Demographics
NPI:1952629966
Name:WOLFSON, MICHELLE MCGRATH (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MCGRATH
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 EL CAMINO REAL
Mailing Address - Street 2:SUITE K
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1607
Mailing Address - Country:US
Mailing Address - Phone:760-431-1819
Mailing Address - Fax:760-431-1345
Practice Address - Street 1:6353 EL CAMINO REAL
Practice Address - Street 2:SUITE K
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1607
Practice Address - Country:US
Practice Address - Phone:760-431-1819
Practice Address - Fax:760-431-1345
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist