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General NPI Number Information
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NPI Number | 1598203002
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Entity Type | Organization
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Legal Business Name | WOLF PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 3830 PACKARD ST SUITE 110
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City | ANN ARBOR
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State | MI
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Zip | 48108-2051
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Country | US
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Telephone | 734-255-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 3830 PACKARD ST SUITE 110
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City | ANN ARBOR
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State | MI
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Zip | 48108-2051
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Country | US
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Telephone | 734-255-8722
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MICHELE WOLF
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Credential |
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Telephone | 734-255-8722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301013207
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License Number State | MI
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