Healthcare Provider Details

I. General information

NPI: 1831925031
Provider Name (Legal Business Name): SHARISSA ROLFE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARISSA WELLS

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

IV. Provider business mailing address

144 PARKBROOK CIR
TALLAHASSEE FL
32301-8912
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5100
  • Fax:
Mailing address:
  • Phone: 904-662-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW23574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: