Individual
MRS. JEANENE JACOBS WOLFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
715 9TH ST, VIRGINIA BEACH, VA 23451-4501
(757) 515-2693
(757) 414-9007
Mailing address
715 9TH ST, VIRGINIA BEACH, VA 23451-4501
(757) 515-2693
(757) 414-9007
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904007144
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020206F27
MEDICARE PTAN
VA
01
—
Q50959F332
MEDICARE PTAN
VA
Enumeration date
06/06/2009
Last updated
10/21/2019
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