Healthcare Provider Details

I. General information

NPI: 1326655580
Provider Name (Legal Business Name): WISE BRIDGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 W MARKET ST STE 124-6
FAIRLAWN OH
44333-3608
US

IV. Provider business mailing address

1913 AUTEN DR
AKRON OH
44320-1103
US

V. Phone/Fax

Practice location:
  • Phone: 330-338-6677
  • Fax:
Mailing address:
  • Phone: 330-962-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE SHENIECE RICE
Title or Position: OWNER
Credential: LPCC-S
Phone: 330-338-6677