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General NPI Number Information
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NPI Number | 1790259703
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Entity Type | Organization
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Legal Business Name | DIVINE WELLNESS & COUNSELING, LLC
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 5205 N IRONWOOD RD STE 117
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City | GLENDALE
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State | WI
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Zip | 53217-4907
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Country | US
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Telephone | 414-502-9355
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Fax | 414-396-4101
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Provider Business Mailing Address
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Address Line | 5205 N IRONWOOD RD STE 117
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City | GLENDALE
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State | WI
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Zip | 53217-4907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPC/ OWNER
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Name | DONETTA WALKER
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Credential | LPC
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Telephone | 414-502-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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