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General NPI Number Information
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NPI Number | 1780942334
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Entity Type | Individual
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Provider Name | MARION CORNELIUS WOLFE JR. ASW70101
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Gender | Male
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 900 FULTON AVE STE 205
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City | SACRAMENTO
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State | CA
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Zip | 95825-4517
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Country | US
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Telephone | 916-484-3570
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Fax | 916-484-3577
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Provider Business Mailing Address
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Address Line | 6011 STACY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95823-3945
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Country | US
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Telephone | 916-583-1035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW70101
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 70101
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 03-109797
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License Number State | CA
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