Doctor Name: | JEFF WOLFGANG |
NPI Number: | 1033588249 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH. D. |
License Number: | IMH 13765 |
Business Practice Address: | 6950 Philips Hwy Ste 11 Jacksonville, FL - 322166082 |
Business Phone Number: | 9042393677 |
Business Fax Number: | 9048664029 |
Mailing Address: | 6950 Philips Hwy Ste 11, JACKSONVILLE |
State: | FL |
Postal Code: | 322166082 |
Phone Number: | 9042393677 |
Fax Number: | 9048664029 |
NPI Enumeration Date: | 09/17/2015 |
NPI Last Update Date: | 09/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | IMH 13765 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |