Provider Demographics
NPI:1689241192
Name:WOLFE-TAYLOR, SAMANTHA N (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:N
Last Name:WOLFE-TAYLOR
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 1:6101 N KEYSTONE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2499
Mailing Address - Country:US
Mailing Address - Phone:317-775-9775
Mailing Address - Fax:
Practice Address - Street 1:6101 N KEYSTONE AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2499
Practice Address - Country:US
Practice Address - Phone:317-775-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007458A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical