Provider Demographics
NPI:1285790345
Name:WOLFE, JUDITH GAYLE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:GAYLE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 FALL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3045
Mailing Address - Country:US
Mailing Address - Phone:540-371-9957
Mailing Address - Fax:
Practice Address - Street 1:3100 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3045
Practice Address - Country:US
Practice Address - Phone:540-371-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA067405OtherANTHEM PROVIDER NUMBER