Provider Demographics
NPI:1417313453
Name:JEANENE J WOLFE, LCSW LLC
Entity Type:Organization
Organization Name:JEANENE J WOLFE, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-515-2693
Mailing Address - Street 1:715 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4501
Mailing Address - Country:US
Mailing Address - Phone:757-515-2693
Mailing Address - Fax:757-414-9007
Practice Address - Street 1:715 9TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4501
Practice Address - Country:US
Practice Address - Phone:757-515-2693
Practice Address - Fax:757-414-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007144251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF332Medicare PIN