Provider Demographics
NPI:1912498650
Name:WOLF, LINDA A (MS, NBCC, LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:MS, NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 BRALY DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5317
Mailing Address - Country:US
Mailing Address - Phone:843-990-1262
Mailing Address - Fax:
Practice Address - Street 1:1710 TROLLEY RD STE E
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8281
Practice Address - Country:US
Practice Address - Phone:800-552-4357
Practice Address - Fax:678-388-9244
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2892Medicaid