Provider Demographics
NPI:1275772600
Name:WOLF, MELISSA A (LPCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-6918
Mailing Address - Country:US
Mailing Address - Phone:505-288-7025
Mailing Address - Fax:
Practice Address - Street 1:28 WINDMILL RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6918
Practice Address - Country:US
Practice Address - Phone:505-288-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional