Provider Demographics
NPI:1598551723
Name:WOLF, NICOLE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:WOLF
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 WINDING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2566
Mailing Address - Country:US
Mailing Address - Phone:770-235-4968
Mailing Address - Fax:
Practice Address - Street 1:5013 WINDING HILLS LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2566
Practice Address - Country:US
Practice Address - Phone:770-235-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health