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General NPI Number Information
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NPI Number | 1598267288
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Entity Type | Organization
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Legal Business Name | WISE WILLOW COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 2875 NORTHWIND DR STE 215
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City | EAST LANSING
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State | MI
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Zip | 48823
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Country | US
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Telephone | 989-277-9617
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Fax | 517-882-6181
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Provider Business Mailing Address
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Address Line | 2875 NORTHWIND DR STE 215
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City | EAST LANSING
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State | MI
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Zip | 48823-5035
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Country | US
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Telephone | 989-277-9617
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Fax | 517-882-6181
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA DUBEY-ZERKA
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Credential | LMSW
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Telephone | 989-277-9617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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