MEDICARE: NICOLE MARIE WOLF LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC003715	GA

General Provider Information

NPI Number	:	1598551723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE WOLF LPC

Provider Business Mailing Address
First Line	:	5013 WINDING HILLS LN
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-2566
Country	:	US
Telephone Number	:	770-235-4968
Fax Number	:

Provider Business Practice Location Address
First Line	:	5013 WINDING HILLS LN
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-2566
Country	:	US
Telephone Number	:	770-235-4968
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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