Healthcare Provider Details

I. General information

NPI: 1336094366
Provider Name (Legal Business Name): NICOLE ALYSON WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N BLACKSTONE AVE
FRESNO CA
93701-1939
US

IV. Provider business mailing address

2940 N FRESNO ST
FRESNO CA
93703-1123
US

V. Phone/Fax

Practice location:
  • Phone: 559-939-5999
  • Fax:
Mailing address:
  • Phone: 559-939-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: