Provider Demographics
NPI:1245878958
Name:WHITE WOLF MINISTRY
Entity type:Organization
Organization Name:WHITE WOLF MINISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCETOLA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:973-300-4594
Mailing Address - Street 1:7959 VT ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:BRIDPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05734-4401
Mailing Address - Country:US
Mailing Address - Phone:973-476-3648
Mailing Address - Fax:
Practice Address - Street 1:7959 VT ROUTE 125
Practice Address - Street 2:
Practice Address - City:BRIDPORT
Practice Address - State:VT
Practice Address - Zip Code:05734-4401
Practice Address - Country:US
Practice Address - Phone:802-758-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPIRIT CONGREGATIONAL CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty