Healthcare Provider Details

I. General information

NPI: 1528599909
Provider Name (Legal Business Name): CHERYL WULFF CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W PARK DR
LORAIN OH
44053-1138
US

IV. Provider business mailing address

2115 W PARK DR
LORAIN OH
44053-1138
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-4987
  • Fax: 440-246-0189
Mailing address:
  • Phone: 440-989-4987
  • Fax: 440-246-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.060451
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: