Provider Demographics
NPI:1750449203
Name:DE WOLFE, STEPHANIE K (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:DE WOLFE
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 1:1506 WINDING WAY DR
Mailing Address - Street 2:204
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5391
Mailing Address - Country:US
Mailing Address - Phone:281-482-9222
Mailing Address - Fax:281-482-9222
Practice Address - Street 1:1506 WINDING WAY DR
Practice Address - Street 2:204
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5391
Practice Address - Country:US
Practice Address - Phone:281-482-9222
Practice Address - Fax:281-482-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00216POtherTHIS IS JUST THE MEDICARE NUMBER I WAS GIVEN IM UNCERTAIN EXACTLY WHAT IT IS