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General NPI Number Information
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NPI Number | 1417107590
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Entity Type | Organization
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Legal Business Name | NEW HOPE COUNSELING CENTER OF WI, INC.
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 3021 HOLMGREN WAY #203
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City | GREEN BAY
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State | WI
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Zip | 54304-6302
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Country | US
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Telephone | 920-338-0100
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Fax | 920-338-0103
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Provider Business Mailing Address
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Address Line | 3021 HOLMGREN WAY #203
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City | GREEN BAY
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State | WI
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Zip | 54304-6302
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Country | US
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Telephone | 920-338-0100
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Fax | 920-338-0103
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MRS. KRISTIN MICHELLE LAWNICZAK
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Credential | LPC, NCC, CEAP
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Telephone | 920-338-0100
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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 | 2760-125
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License Number State | WI
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