Provider Demographics
NPI:1720481849
Name:WOLTER, MARGUERITE PATY
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:PATY
Last Name:WOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEG
Other - Middle Name:PATY
Other - Last Name:WOLTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:401 KAMAKEE ST STE 305
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4243
Mailing Address - Country:US
Mailing Address - Phone:808-596-4555
Mailing Address - Fax:
Practice Address - Street 1:401 KAMAKEE ST STE 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4243
Practice Address - Country:US
Practice Address - Phone:808-596-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional