Healthcare Provider Details

I. General information

NPI: 1902359615
Provider Name (Legal Business Name): WOLFF PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6324 LOFTUS AVE NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6324 LOFTUS AVE NE
ALBUQUERQUE NM
87109-2718
US

V. Phone/Fax

Practice location:
  • Phone: 505-369-6206
  • Fax: 505-323-5651
Mailing address:
  • Phone: 505-507-1022
  • Fax: 505-323-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0179961
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-08546
License Number StateNM

VIII. Authorized Official

Name: MS. PAMELA ANN WOLFF
Title or Position: PRESIDENT/PROVIDER
Credential: LCSW, LADAC
Phone: 505-507-1022