Provider Demographics
NPI:1669608444
Name:WOLFE, JEANENE JACOBS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEANENE
Middle Name:JACOBS
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4501
Mailing Address - Country:US
Mailing Address - Phone:757-515-2693
Mailing Address - Fax:757-414-9007
Practice Address - Street 1:715 9TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4501
Practice Address - Country:US
Practice Address - Phone:757-515-2693
Practice Address - Fax:757-414-9007
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020206F27OtherMEDICARE PTAN
VAQ50959F332OtherMEDICARE PTAN