Healthcare Provider Details

I. General information

NPI: 1417812918
Provider Name (Legal Business Name): CARMELLA WOLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 6TH AVE
DE WITT IA
52742-1331
US

IV. Provider business mailing address

1103 BROOKVIEW DR
DE WITT IA
52742-9290
US

V. Phone/Fax

Practice location:
  • Phone: 708-288-8769
  • Fax:
Mailing address:
  • Phone: 563-293-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CARMELLA ANGELINA WOLD
Title or Position: OWNER/THERAPIST
Credential: LCSW, LISW
Phone: 708-288-8769