Provider Demographics
NPI:1265299440
Name:WOLF, REBECCA (LCMHCA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 AEGEAN CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5919
Mailing Address - Country:US
Mailing Address - Phone:704-930-8559
Mailing Address - Fax:980-788-9900
Practice Address - Street 1:20605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8454
Practice Address - Country:US
Practice Address - Phone:980-788-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health