Provider Demographics
NPI:1053494690
Name:WOLFE, JUDITH L (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 WINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4757
Mailing Address - Country:US
Mailing Address - Phone:706-513-1313
Mailing Address - Fax:706-733-1098
Practice Address - Street 1:211 PLEASANT HOME RD
Practice Address - Street 2:SUITE B-2
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0518
Practice Address - Country:US
Practice Address - Phone:706-513-1313
Practice Address - Fax:706-854-0432
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GA000606317BMedicaid