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General NPI Number Information
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NPI Number | 1194233718
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Entity Type | Organization
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Legal Business Name | THE EVOLVING CHAIR COUNSELING AND CONSULTING AGENCY
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 3100 N 78TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3916
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Country | US
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Telephone | 414-395-0037
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Fax |
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Provider Business Mailing Address
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Address Line | 7425 W FLORIST AVE
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City | MILWAUKEE
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State | WI
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Zip | 53218-1850
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Country | US
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Telephone | 414-748-1614
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHILD & FAMILY THERAPIST
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Name | MS. LAKIESHA RUSSELL
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Credential | LPC
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Telephone | 414-395-0037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6098-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6098-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6098-125
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License Number State | WI
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