Provider Demographics
NPI:1851176218
Name:WOLFE, TAMMY JO
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1398
Mailing Address - Country:US
Mailing Address - Phone:740-446-6471
Mailing Address - Fax:
Practice Address - Street 1:788 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:OH
Practice Address - Zip Code:45760-1014
Practice Address - Country:US
Practice Address - Phone:740-992-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.182310101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)