Provider Demographics
NPI:1093172207
Name:WOLFE, EILEEN (LMHC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAYOU BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1949
Mailing Address - Country:US
Mailing Address - Phone:850-418-4990
Mailing Address - Fax:
Practice Address - Street 1:4300 BAYOU BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1949
Practice Address - Country:US
Practice Address - Phone:850-418-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health