Healthcare Provider Details

I. General information

NPI: 1205136090
Provider Name (Legal Business Name): ANNA MARIA GODIALI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADVANTAGE COUNSELING

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HILLCREST COUNSELING LLC 15110 BENDING BRAE COURT
BROOKFIELD WI
53005-2681
US

IV. Provider business mailing address

HILLCREST COUNSELING LLC 15110 BENDING BRAE COURT
BROOKFIELD WI
53005-2681
US

V. Phone/Fax

Practice location:
  • Phone: 262-244-9350
  • Fax: 989-893-3528
Mailing address:
  • Phone: 262-244-9350
  • Fax: 989-893-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008740
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7707-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: