Provider Demographics
NPI:1952498297
Name:WOLFE, VIRGINIA (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:WOLFE
Other - Last Name:COTHRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,LP
Mailing Address - Street 1:400 SIBLEY ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1941
Mailing Address - Country:US
Mailing Address - Phone:651-256-1242
Mailing Address - Fax:651-291-7378
Practice Address - Street 1:400 SIBLEY ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1941
Practice Address - Country:US
Practice Address - Phone:651-256-1242
Practice Address - Fax:651-291-7378
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3030103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN666822400Medicaid