Healthcare Provider Details

I. General information

NPI: 1902553316
Provider Name (Legal Business Name): WISE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2022
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 PEACH ST # 201
ERIE PA
16509-1374
US

IV. Provider business mailing address

4408 PEACH ST # 201
ERIE PA
16509-1374
US

V. Phone/Fax

Practice location:
  • Phone: 814-392-5681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WISE
Title or Position: PARTNER
Credential: DO
Phone: 814-392-5681