Healthcare Provider Details

I. General information

NPI: 1073297628
Provider Name (Legal Business Name): MEGAN RICCA WOLFF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 NORTHEAST EXPY NE
BROOKHAVEN GA
30329-2317
US

IV. Provider business mailing address

55 SAGEBROOK LN
NEWNAN GA
30263-4864
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900411
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2460
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: