Provider Demographics
NPI:1053049304
Name:WOLFE, BETHEL GRACE (MS, SUDPT)
Entity type:Individual
Prefix:MRS
First Name:BETHEL
Middle Name:GRACE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MS, SUDPT
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Mailing Address - Street 1:12850 LALA COVE LN SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9664
Mailing Address - Country:US
Mailing Address - Phone:253-851-2552
Mailing Address - Fax:253-858-8506
Practice Address - Street 1:5122 OLYMPIC DR STE A105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1768
Practice Address - Country:US
Practice Address - Phone:253-851-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)