Provider Demographics
NPI:1093050866
Name:WOLFF, ANNIE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:E
Last Name:WOLFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:C
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9488 W FLAMINGO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5717
Mailing Address - Country:US
Mailing Address - Phone:702-239-8245
Mailing Address - Fax:
Practice Address - Street 1:6730 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5396
Practice Address - Country:US
Practice Address - Phone:702-665-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8192-C1041C0700X, 261QR0400X
1041C0700X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner