Provider Demographics
NPI:1528899168
Name:WOLF, RYAN D (RCSWI)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 FOREST BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9799
Mailing Address - Country:US
Mailing Address - Phone:850-860-2177
Mailing Address - Fax:
Practice Address - Street 1:6232 FOREST BAY AVE
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9799
Practice Address - Country:US
Practice Address - Phone:850-860-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW18480101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor