Provider Demographics
NPI:1104973817
Name:MCVEY-WOLVERTON, PHYLLIS ANN (MSW LISW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANN
Last Name:MCVEY-WOLVERTON
Suffix:
Gender:F
Credentials:MSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 E MAIN ST
Mailing Address - Street 2:SUITE #203
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2535
Mailing Address - Country:US
Mailing Address - Phone:614-237-0309
Mailing Address - Fax:614-231-2951
Practice Address - Street 1:2691 E MAIN ST
Practice Address - Street 2:SUITE #203
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2535
Practice Address - Country:US
Practice Address - Phone:614-237-0309
Practice Address - Fax:614-231-2951
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104987- LICSW1041C0700X
OHI-0004741 OH LISW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical