Provider Demographics
NPI:1811282130
Name:WOLFISH, JEFFREY STUART (LCPC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STUART
Last Name:WOLFISH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HATTON RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4513
Mailing Address - Country:US
Mailing Address - Phone:201-787-1216
Mailing Address - Fax:410-843-7585
Practice Address - Street 1:5750 PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3930
Practice Address - Country:US
Practice Address - Phone:410-843-7384
Practice Address - Fax:410-843-7585
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional