Healthcare Provider Details

I. General information

NPI: 1952815607
Provider Name (Legal Business Name): EILEEN RACHEL WOLFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

1248 JASPER ST
CANTONMENT FL
32533-7726
US

V. Phone/Fax

Practice location:
  • Phone: 850-439-2100
  • Fax: 850-439-2122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13864
License Number StateFL

VIII. Authorized Official

Name: EILEEN WOLFE
Title or Position: OWNER
Credential: LMHC
Phone: 850-439-2100