Healthcare Provider Details

I. General information

NPI: 1346430303
Provider Name (Legal Business Name): LASHAWNDA R DAVIS CURRENT INITIATIVES COUNSELING SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6815 W CAPITOL DR ROOM 311
MILWAUKEE WI
53216-2070
US

IV. Provider business mailing address

6815 W CAPITOL DR ROOM 311
MILWAUKEE WI
53216-2070
US

V. Phone/Fax

Practice location:
  • Phone: 414-616-8805
  • Fax: 414-616-2296
Mailing address:
  • Phone: 414-616-8805
  • Fax: 414-616-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number251C00000X
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number39773300
License Number StateWI

VIII. Authorized Official

Name: MS. LASHAWNDA DAVIS
Title or Position: DIRECTOR/PSYCHOTHERAPIST
Credential: MS, CAPSW
Phone: 414-628-5495