Healthcare Provider Details

I. General information

NPI: 1447687066
Provider Name (Legal Business Name): RIVERSTONE COUNSELING & CRISIS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8018 W CAPITOL DR
MILWAUKEE WI
53222-1906
US

IV. Provider business mailing address

8018 W CAPITOL DR UNIT 6
MILWAUKEE WI
53222-1906
US

V. Phone/Fax

Practice location:
  • Phone: 414-559-8864
  • Fax:
Mailing address:
  • Phone: 414-559-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8016-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3101
License Number StateWI

VIII. Authorized Official

Name: SARA J NEWMAN
Title or Position: EXECUTIVE DIRECTOR/THERAPIST
Credential: LCSW
Phone: 414-559-8864