Provider Demographics
NPI:1730268152
Name:WOLFE, KAREN L (MA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2166
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6442
Mailing Address - Country:US
Mailing Address - Phone:770-459-1952
Mailing Address - Fax:
Practice Address - Street 1:135 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2708
Practice Address - Country:US
Practice Address - Phone:770-459-1952
Practice Address - Fax:770-459-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional