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General NPI Number Information
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NPI Number | 1003126970
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Entity Type | Individual
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Provider Name | LISA POLK-WOOLFOLK MS, LLPC, CAC-M
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Gender | Female
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 3731 RIVARD ST
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City | DETROIT
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State | MI
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Zip | 48207-4740
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Country | US
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Telephone | 313-258-9713
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 RIVARD ST
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City | DETROIT
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State | MI
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Zip | 48207-4740
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Country | US
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Telephone | 313-258-9713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 104717
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012200
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802063821
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License Number State | MI
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