Provider Demographics
NPI:1982076949
Name:WOLFE, DEANNA L (MA CLINICAL PSYCH)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3984 MATCH POINT AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407
Mailing Address - Country:US
Mailing Address - Phone:707-321-3198
Mailing Address - Fax:
Practice Address - Street 1:3952 SEBASTOPOL RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6677
Practice Address - Country:US
Practice Address - Phone:707-321-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health