Healthcare Provider Details

I. General information

NPI: 1093533887
Provider Name (Legal Business Name): CANDICE WOLFF BEHAVIORAL CONSULTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 MARSH CT
FREDERICKSBURG VA
22407-8422
US

IV. Provider business mailing address

6510 MARSH CT
FREDERICKSBURG VA
22407-8422
US

V. Phone/Fax

Practice location:
  • Phone: 850-307-8811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: CANDICE WOLFF
Title or Position: OWNER/BCBA
Credential:
Phone: 850-307-8811