Provider Demographics
NPI:1053658401
Name:WOLFDANE, YOLANDA G (LCDC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:G
Last Name:WOLFDANE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-261-1000
Mailing Address - Fax:210-731-8678
Practice Address - Street 1:3031 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5159
Practice Address - Country:US
Practice Address - Phone:210-261-1000
Practice Address - Fax:210-731-8678
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10267101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional