Provider Demographics
NPI:1700538030
Name:WOLF, ALISA (LMHCA)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 NE 215TH PL
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9007
Mailing Address - Country:US
Mailing Address - Phone:303-257-8833
Mailing Address - Fax:
Practice Address - Street 1:16701 SE MCGILLIVRAY BLVD # 140
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3485
Practice Address - Country:US
Practice Address - Phone:503-683-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61180047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health