Doctor Name: | MRS. CARMELLA A WOLD |
NPI Number: | 1215294541 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | 6801094107 |
Business Practice Address: | 1850 Colfax Ave Benton Harbor, MI - 490229999 |
Business Phone Number: | 2699266199 |
Business Fax Number: | 2699266780 |
Mailing Address: | 1850 Colfax Ave, BENTON HARBOR |
State: | MI |
Postal Code: | 490229999 |
Phone Number: | 2699266199 |
Fax Number: | 2699266780 |
NPI Enumeration Date: | 04/11/2012 |
NPI Last Update Date: | 04/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 6801094107 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |