Provider Demographics
NPI:1235600388
Name:WOOLFOLK, TAWANDA J (MS, RBT)
Entity Type:Individual
Prefix:MS
First Name:TAWANDA
Middle Name:J
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:MS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 ESPLANADE WAY APT 7103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3754
Mailing Address - Country:US
Mailing Address - Phone:850-339-6632
Mailing Address - Fax:
Practice Address - Street 1:3550 ESPLANADE WAY APT 7103
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3754
Practice Address - Country:US
Practice Address - Phone:850-339-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician