Provider Demographics
NPI:1609838572
Name:WOLFE, SAMUEL CONLEY (LPCC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CONLEY
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ELLEN KAY DR
Mailing Address - Street 2:STE D
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6286
Mailing Address - Country:US
Mailing Address - Phone:740-382-3874
Mailing Address - Fax:740-382-2930
Practice Address - Street 1:1125 ELLEN KAY DR
Practice Address - Street 2:STE D
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6286
Practice Address - Country:US
Practice Address - Phone:740-382-3874
Practice Address - Fax:740-382-2930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional