Provider Demographics
NPI:1104213925
Name:WINGS ENRICHMENT CENTER
Entity Type:Organization
Organization Name:WINGS ENRICHMENT CENTER
Other - Org Name:WINGS SUPPORT AND RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JULLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIESHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC, LSW
Authorized Official - Phone:937-642-9555
Mailing Address - Street 1:729 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1643
Mailing Address - Country:US
Mailing Address - Phone:937-642-9555
Mailing Address - Fax:937-738-7326
Practice Address - Street 1:729 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1643
Practice Address - Country:US
Practice Address - Phone:937-642-9555
Practice Address - Fax:937-738-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty