Provider Demographics
NPI:1497985535
Name:WOLF, PATRICIA JOANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOANN
Last Name:WOLF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FALCON WAY SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8871
Mailing Address - Country:US
Mailing Address - Phone:706-816-7865
Mailing Address - Fax:478-200-5165
Practice Address - Street 1:1111 MILLEDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8807
Practice Address - Country:US
Practice Address - Phone:706-816-7865
Practice Address - Fax:478-200-5165
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0021981041C0700X
GACSW002198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002198OtherLCSW