Provider Demographics
NPI:1568722247
Name:WOLFF, JUSTIN BLAKE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:BLAKE
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24123 BOERNE STAGE ROAD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9401
Mailing Address - Country:US
Mailing Address - Phone:210-475-2848
Mailing Address - Fax:
Practice Address - Street 1:24123 BOERNE STAGE ROAD
Practice Address - Street 2:SUITE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9401
Practice Address - Country:US
Practice Address - Phone:210-475-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional