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General NPI Number Information
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NPI Number | 1245878958
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Entity Type | Organization
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Legal Business Name | WHITE WOLF MINISTRY
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 7959 VT ROUTE 125
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City | BRIDPORT
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State | VT
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Zip | 05734-4401
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Country | US
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Telephone | 802-758-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 7959 VT ROUTE 125
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City | BRIDPORT
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State | VT
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Zip | 05734-4401
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Country | US
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Telephone | 973-476-3648
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Fax |
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Authorized Official
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Title or Position | TRUSTEE
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Name | RALPH FUCETOLA
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Credential | JD
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Telephone | 973-300-4594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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