Healthcare Provider Details

I. General information

NPI: 1205880341
Provider Name (Legal Business Name): MICHAEL WILLIAM WOLFE LMSW, CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W MAIN ST STE 206
MIDLAND MI
48640-5184
US

IV. Provider business mailing address

100 NORTHBOUND GRATIOT AVE
MOUNT CLEMENS MI
48043-2301
US

V. Phone/Fax

Practice location:
  • Phone: 989-244-1888
  • Fax: 586-690-4333
Mailing address:
  • Phone: 586-783-2950
  • Fax: 586-690-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801061414
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: