Provider Demographics
NPI:1902512916
Name:THE WOLF'S REFUGE: COUNSELING AND HEALING SERVICES PLLC.
Entity Type:Organization
Organization Name:THE WOLF'S REFUGE: COUNSELING AND HEALING SERVICES PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWA
Authorized Official - Phone:336-482-7858
Mailing Address - Street 1:6020 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-6184
Mailing Address - Country:US
Mailing Address - Phone:336-482-7858
Mailing Address - Fax:
Practice Address - Street 1:6020 W PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-6184
Practice Address - Country:US
Practice Address - Phone:336-482-7858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)