Basic Information
| Provider Information | |||||||||
| NPI: | 1750697306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLHAUPTER | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 509 | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047690509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077646825 | ||||||||
| FaxNumber: | 2077646077 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047693101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077646825 | ||||||||
| FaxNumber: | 2077646077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2010 | ||||||||
| LastUpdateDate: | 08/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CAC4120 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.