Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | SW005115E | PA |
NPI | 1003038829 |
---|---|
Provider Name | Mr. Ronald Kent Wolf |
First Address | Lebanon, PA 17042-4485 |
Second Address | Harrisburg, PA 17104-2547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |