Provider Demographics
NPI:1588982623
Name:STEPHANIE K. DEWOLFE, LCSW, PLLC
Entity type:Organization
Organization Name:STEPHANIE K. DEWOLFE, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:DEWOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-787-6186
Mailing Address - Street 1:1506 WINDING WAY DR
Mailing Address - Street 2:STE #204
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5391
Mailing Address - Country:US
Mailing Address - Phone:281-482-9222
Mailing Address - Fax:281-482-9222
Practice Address - Street 1:1506 WINDING WAY DR
Practice Address - Street 2:STE #204
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5391
Practice Address - Country:US
Practice Address - Phone:281-482-9222
Practice Address - Fax:281-482-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00216PMedicare PIN