Provider Demographics
NPI:1144347931
Name:WOLFE, SUSAN TIPTON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TIPTON
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAURELWOOD CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8559
Mailing Address - Country:US
Mailing Address - Phone:731-660-8516
Mailing Address - Fax:731-660-8516
Practice Address - Street 1:19 LAURELWOOD CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8559
Practice Address - Country:US
Practice Address - Phone:731-660-8516
Practice Address - Fax:731-660-8516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000003671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN091027OtherVALUEOPTIONS
TN2008640OtherBLUECROSS BLUESHIELD TN