Provider Demographics
NPI:1114412061
Name:WOLFF, LISA (LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WOLFF
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3804
Mailing Address - Country:US
Mailing Address - Phone:410-212-3197
Mailing Address - Fax:410-741-3563
Practice Address - Street 1:16010 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3043
Practice Address - Country:US
Practice Address - Phone:410-212-3197
Practice Address - Fax:410-741-3563
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9061101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional