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General NPI Number Information
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NPI Number | 1851738009
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Entity Type | Organization
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Legal Business Name | IMANI COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 13500 W CAPITOL DR SUITE 104
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City | BROOKFIELD
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State | WI
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Zip | 53005-2444
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Country | US
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Telephone | 414-737-1820
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Fax | 414-455-5405
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Provider Business Mailing Address
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Address Line | 13500 W CAPITOL DR SUITE 104
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City | BROOKFIELD
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State | WI
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Zip | 53005-2444
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Country | US
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Telephone | 414-737-1820
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Fax | 414-455-5405
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Authorized Official
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Title or Position | OWNER / PSYCHOTHERAPIST
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Name | MRS. KIA ANDREA HOLLOWAY
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Credential | MS, LPC
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Telephone | 414-737-1820
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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 | 413-7125
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License Number State | WI
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