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General NPI Number Information
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NPI Number | 1972710481
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Entity Type | Organization
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Legal Business Name | NOVA COUNSELING ALTERNATIVES LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 1941 E SPRING ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-1658
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Country | US
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Telephone | 812-206-3291
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Fax | 812-206-3296
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Provider Business Mailing Address
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Address Line | PO BOX 413
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City | NEW ALBANY
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State | IN
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Zip | 47151-0413
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Country | US
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Telephone | 812-206-3291
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SELENA B. WISMAN
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Credential | LMFT
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Telephone | 812-206-3291
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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 | 34003588A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004562A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1042
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001423A
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License Number State | IN
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