Individual
SAMELLA JOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2800 E ENTERPRISE AVE STE 333, APPLETON, WI 54913-7889
(920) 200-5594
Mailing address
2800 E ENTERPRISE AVE STE 333, APPLETON, WI 54913-7889
(920) 200-5594
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
131275-121
WI
1041C0700X
Clinical Social Worker
Primary
10231-123
WI
1041C0700X
Clinical Social Worker
127301
IA
1041C0700X
Clinical Social Worker
34012465A
IN
Other
Enumeration date
07/08/2021
Last updated
01/13/2026
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