Provider Demographics
NPI:1336759893
Name:WOLFF, SHEAUNNA CAMILLE
Entity Type:Individual
Prefix:
First Name:SHEAUNNA
Middle Name:CAMILLE
Last Name:WOLFF
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:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:EAST OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98540-0805
Mailing Address - Country:US
Mailing Address - Phone:360-764-0555
Mailing Address - Fax:
Practice Address - Street 1:8315 NORMANDY ST SE UNIT 805
Practice Address - Street 2:
Practice Address - City:EAST OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98540-1037
Practice Address - Country:US
Practice Address - Phone:360-776-4968
Practice Address - Fax:360-326-1168
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61178983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health