Provider Demographics
NPI:1033305206
Name:ENSOR, JOY WOLFE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:WOLFE
Last Name:ENSOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 OAK VALLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8943
Mailing Address - Country:US
Mailing Address - Phone:734-995-5181
Mailing Address - Fax:734-995-9011
Practice Address - Street 1:2395 OAK VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8943
Practice Address - Country:US
Practice Address - Phone:734-995-5181
Practice Address - Fax:734-995-9011
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003018103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-0-H1-1769-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN