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General NPI Number Information
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NPI Number | 1447466065
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Entity Type | Organization
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Legal Business Name | TOMAHAWK COUNSELING CENTER
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1345 W MASON ST STE L8
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City | GREEN BAY
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State | WI
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Zip | 54303-2072
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Country | US
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Telephone | 920-405-9701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12556
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City | GREEN BAY
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State | WI
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Zip | 54307-2556
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Country | US
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Telephone | 920-405-9701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTI H KOVACS
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Credential |
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Telephone | 920-405-9701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2394
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License Number State | WI
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