Healthcare Provider Details

I. General information

NPI: 1699358481
Provider Name (Legal Business Name): JULIA WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CENTER ST
CLAY WV
25043-7046
US

IV. Provider business mailing address

249 SKIDMORE LN
SUTTON WV
26601-9272
US

V. Phone/Fax

Practice location:
  • Phone: 304-587-7301
  • Fax:
Mailing address:
  • Phone: 304-561-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPL031912846
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: