Healthcare Provider Details

I. General information

NPI: 1336789429
Provider Name (Legal Business Name): CYNTHIA MARIE WOLF LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

15216 NE 50TH ST
VANCOUVER WA
98682-6048
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax: 360-326-9691
Mailing address:
  • Phone: 360-836-1687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61358650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: