Provider Demographics
NPI:1841988094
Name:WOLFE, JAZMIN ANGEL
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:ANGEL
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SAINT THOMAS DR APT B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4375
Mailing Address - Country:US
Mailing Address - Phone:210-788-4133
Mailing Address - Fax:
Practice Address - Street 1:2206 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2583
Practice Address - Country:US
Practice Address - Phone:757-664-9778
Practice Address - Fax:757-903-0114
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-222406106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician