Provider Demographics
NPI:1316475379
Name:WOLF, ALISHA PATRICE (LGSW, MPH)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:PATRICE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LGSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 POWDER MILL RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3149
Mailing Address - Country:US
Mailing Address - Phone:919-308-2155
Mailing Address - Fax:
Practice Address - Street 1:4061 POWDER MILL RD STE 320
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3149
Practice Address - Country:US
Practice Address - Phone:410-402-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker