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General NPI Number Information
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NPI Number | 1063644979
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Entity Type | Organization
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Legal Business Name | ANGELS COUNSELLING AND THERAPY SERVICE
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 08/12/2009
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Provider Practice Location Address
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Address Line | 1401 N. MARTIN LUTHER KING DR
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City | MILWAUKEE
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State | WI
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Zip | 53212
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Country | US
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Telephone | 414-630-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 N. MARTIN LUTHER KING DR
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City | MILWAUKEE
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State | WI
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Zip | 53212
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Country | US
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Telephone | 414-630-0102
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Fax |
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Authorized Official
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Title or Position | LEAD THERAPIST
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Name | MRS. AUGUSTINA GARBA
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Credential | LPC
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Telephone | 414-630-0102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3758-125
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License Number State | WI
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