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General NPI Number Information
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NPI Number | 1912243288
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Entity Type | Organization
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Legal Business Name | SANKOFA BEHAVIORAL & COMMUNITY HEALTH, INC
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 2810 CROSSROADS DR SUITE 4000
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City | MADISON
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State | WI
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Zip | 53718-7942
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Country | US
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Telephone | 414-202-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 CROSSROADS DR SUITE 4000
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City | MADISON
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State | WI
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Zip | 53718-7942
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Country | US
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Telephone | 414-202-9146
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CLINICIAL
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Name | VALERIE V. HENDERSON
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Credential | DR.
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Telephone | 414-202-9146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3010
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License Number State | WI
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