Provider Demographics
NPI:1538645536
Name:WOLFE, HOLLY ('REE') IRENE
Entity Type:Individual
Prefix:
First Name:HOLLY ('REE')
Middle Name:IRENE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 DUTCH SQUARE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7318
Mailing Address - Country:US
Mailing Address - Phone:803-760-8212
Mailing Address - Fax:
Practice Address - Street 1:810 DUTCH SQUARE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7318
Practice Address - Country:US
Practice Address - Phone:803-760-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional