Healthcare Provider Details

I. General information

NPI: 1336904689
Provider Name (Legal Business Name): WISEMIND COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E ROBINSON ST STE 206B
CARMI IL
62821-1935
US

IV. Provider business mailing address

304 E ROBINSON ST STE 206B
CARMI IL
62821-1935
US

V. Phone/Fax

Practice location:
  • Phone: 407-227-8150
  • Fax:
Mailing address:
  • Phone: 407-227-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEFF WOOD
Title or Position: OWNER
Credential: LCSW
Phone: 407-227-8150