Provider Demographics
NPI:1720134711
Name:WOLAVER, ALTHEA V (PHD)
Entity Type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:V
Last Name:WOLAVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ALTHEA
Other - Middle Name:MAY
Other - Last Name:VANDERWEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66565 ACOMA AVE. #63
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240
Mailing Address - Country:US
Mailing Address - Phone:951-551-4146
Mailing Address - Fax:951-763-0805
Practice Address - Street 1:66565 ACOMA AVE. #63
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240
Practice Address - Country:US
Practice Address - Phone:951-551-4146
Practice Address - Fax:951-763-0805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY16382103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY16382OtherPSYCHOLOGIST LICENSE