Provider Demographics
NPI:1912769001
Name:WOLFE, KASSI (CT)
Entity Type:Individual
Prefix:
First Name:KASSI
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 VILLAGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7760
Mailing Address - Country:US
Mailing Address - Phone:614-329-8862
Mailing Address - Fax:
Practice Address - Street 1:78 VILLAGE POINTE DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7760
Practice Address - Country:US
Practice Address - Phone:614-392-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000792854101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor