Individual
AMANDA JANE DE WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
66 HURLBUT ST, PASADENA, CA 91105-4025
(626) 441-4221
Mailing address
3474 CANYON RIDGE DR, ALTADENA, CA 91001-3724
(626) 390-1803
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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