Provider Demographics
NPI:1235990698
Name:LAVENDER SKIES COUNSELING LLC
Entity Type:Organization
Organization Name:LAVENDER SKIES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-367-4025
Mailing Address - Street 1:1794 ALLOUEZ AVE.
Mailing Address - Street 2:SUITE C, NUMBER 243
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:920-367-4025
Mailing Address - Fax:
Practice Address - Street 1:1794 ALLOUEZ AVE.
Practice Address - Street 2:SUITE C, NUMBER 243
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6281
Practice Address - Country:US
Practice Address - Phone:920-367-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty