Provider Demographics
NPI:1356921910
Name:MIA WOLFREY, LCSW
Entity type:Organization
Organization Name:MIA WOLFREY, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MIA
Authorized Official - Middle Name:MALIKA
Authorized Official - Last Name:WOLFREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:470-772-0740
Mailing Address - Street 1:4649 LIBERTY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4968
Mailing Address - Country:US
Mailing Address - Phone:470-382-8420
Mailing Address - Fax:
Practice Address - Street 1:4649 LIBERTY SQUARE DR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4968
Practice Address - Country:US
Practice Address - Phone:470-382-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WESLEY CENTER FOR BEHAVIORAL WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty