Healthcare Provider Details

I. General information

NPI: 1336877687
Provider Name (Legal Business Name): LISA WOLFE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S WINTER ST STE 1022
ADRIAN MI
49221-3876
US

IV. Provider business mailing address

1040 S WINTER ST STE 1022
ADRIAN MI
49221-3876
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-8905
  • Fax:
Mailing address:
  • Phone: 571-263-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801121124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: