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General NPI Number Information
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NPI Number | 1568824894
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Entity Type | Organization
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Legal Business Name | ATHENA COUNSELING SERVICE
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 358 W 8TH ST
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City | WINONA
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State | MN
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Zip | 55987-2903
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Country | US
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Telephone | 386-847-2653
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Fax |
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Provider Business Mailing Address
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Address Line | 358 W 8TH ST
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City | WINONA
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State | MN
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Zip | 55987-2903
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Country | US
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Telephone | 386-847-2653
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | KRISTINE ANN RADLOFF
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Credential | LPCC
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Telephone | 507-474-4041
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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 | 00403
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License Number State | MN
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