Provider Demographics
NPI:1265527766
Name:WOLF, ELAINE THOMAS (MA)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:THOMAS
Last Name:WOLF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-9651
Mailing Address - Country:US
Mailing Address - Phone:828-245-9732
Mailing Address - Fax:828-287-3102
Practice Address - Street 1:270 N TOMS ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139
Practice Address - Country:US
Practice Address - Phone:828-287-8890
Practice Address - Fax:828-287-3102
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107066Medicaid
NCE1788OtherMEDCOST