Provider Demographics
NPI:1871926493
Name:WOLFE, DANIELLE WOOTERS (LCSW-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:WOOTERS
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:DANIELE
Other - Middle Name:CHRISTINE
Other - Last Name:WOOTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:2336 GODDARD PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1126
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6362
Practice Address - Street 1:2336 GODDARD PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1126
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:410-334-6362
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD346646OtherMHN
MD517251OtherOPTUM
MDR968OtherCAREFIRST BCBS OF MD
MD609550001Medicaid
MD78400093OtherAETNA
MD609550002Medicaid
MD609550004Medicaid
MD346646OtherMHN