Healthcare Provider Details

I. General information

NPI: 1215236534
Provider Name (Legal Business Name): BRANDON L. WOLFE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10765 SAMPLES RD
ALEXANDER AR
72002-8648
US

IV. Provider business mailing address

2400 KING DAVID PARK
LITTLE ROCK AR
72210-5063
US

V. Phone/Fax

Practice location:
  • Phone: 501-773-5341
  • Fax:
Mailing address:
  • Phone: 501-773-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6535-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: