Provider Demographics
NPI:1669705356
Name:WOLF, TESSA TRUSSELL (PSYD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:TRUSSELL
Last Name:WOLF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E CROSSVILLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3086
Mailing Address - Country:US
Mailing Address - Phone:770-410-8158
Mailing Address - Fax:
Practice Address - Street 1:77 E CROSSVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3086
Practice Address - Country:US
Practice Address - Phone:770-410-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical