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General NPI Number Information
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NPI Number | 1205347945
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Entity Type | Individual
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Provider Name | LILY ELIZABETH WOLF LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 5775 GLENRIDGE DR STE 310
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City | ATLANTA
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State | GA
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Zip | 30328-5380
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Country | US
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Telephone | 216-245-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 5775 GLENRIDGE DR STE 310
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City | ATLANTA
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State | GA
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Zip | 30328-5380
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Country | US
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Telephone | 347-563-5736
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1701084
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW007468
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License Number State | GA
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