Provider Demographics
NPI:1063644979
Name:ANGELS COUNSELLING AND THERAPY SERVICE
Entity Type:Organization
Organization Name:ANGELS COUNSELLING AND THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:414-630-0102
Mailing Address - Street 1:1401 N. MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212
Mailing Address - Country:US
Mailing Address - Phone:414-630-0102
Mailing Address - Fax:
Practice Address - Street 1:1401 N. MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-630-0102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3758-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43703200Medicaid