Basic Information
| Provider Information | |||||||||
| NPI: | 1669705356 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | TESSA | ||||||||
| MiddleName: | TRUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 E CROSSVILLE RD STE 207 | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300753086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704108158 | ||||||||
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| Practice Location | |||||||||
| Address1: | 131 W MIDWAY DR | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928056507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145177107 | ||||||||
| FaxNumber: | 7149561990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY004273 | GA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.