Healthcare Provider Details

I. General information

NPI: 1912243288
Provider Name (Legal Business Name): SANKOFA BEHAVIORAL & COMMUNITY HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 CROSSROADS DR SUITE 4000
MADISON WI
53718-7942
US

IV. Provider business mailing address

2810 CROSSROADS DR SUITE 4000
MADISON WI
53718-7942
US

V. Phone/Fax

Practice location:
  • Phone: 414-202-9146
  • Fax:
Mailing address:
  • Phone: 414-202-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3010
License Number StateWI

VIII. Authorized Official

Name: VALERIE V. HENDERSON
Title or Position: DIRECTOR/CLINICIAL
Credential: DR.
Phone: 414-202-9146