Provider Demographics
NPI:1336877687
Name:WOLFE, LISA (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 CALVIN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4112
Mailing Address - Country:US
Mailing Address - Phone:231-557-4620
Mailing Address - Fax:
Practice Address - Street 1:1060 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-4175
Practice Address - Country:US
Practice Address - Phone:231-777-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)