Provider Demographics
NPI:1609911726
Name:WOLFE, JANNAT F (LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:JANNAT
Middle Name:F
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1104
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:31891 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-9006
Practice Address - Country:US
Practice Address - Phone:740-596-5249
Practice Address - Fax:740-775-7855
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH912917101YA0400X
OHS.0026461104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)