Provider Demographics
NPI:1275176968
Name:WISHING WELL COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:WISHING WELL COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, CCTP, NCC
Authorized Official - Phone:678-948-9817
Mailing Address - Street 1:540 POWDER SPRINGS ST STE C17
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3561
Mailing Address - Country:US
Mailing Address - Phone:678-948-6817
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST STE C17
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3561
Practice Address - Country:US
Practice Address - Phone:678-948-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty