MEDICARE: WOLF COUNSELING & CLINICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1053178038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOLF COUNSELING & CLINICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	9735 AEGEAN CT
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5919
Country	:	US
Telephone Number	:	704-930-8559
Fax Number	:	980-788-9900

Provider Business Practice Location Address
First Line	:	20605 N MAIN ST
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-8454
Country	:	US
Telephone Number	:	980-788-9800
Fax Number	:	980-788-9900

Authorized Official
Title or Position	:	OWNER
Name	:	REBECCA WOLF
Credential	:	LCMHCA
Telephone Number	:	704-930-8559

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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