Provider Demographics
NPI:1346430303
Name:LASHAWNDA R DAVIS CURRENT INITIATIVES COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:LASHAWNDA R DAVIS CURRENT INITIATIVES COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHAWNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAPSW
Authorized Official - Phone:414-628-5495
Mailing Address - Street 1:6815 W CAPITOL DR
Mailing Address - Street 2:ROOM 311
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2070
Mailing Address - Country:US
Mailing Address - Phone:414-616-8805
Mailing Address - Fax:414-616-2296
Practice Address - Street 1:6815 W CAPITOL DR
Practice Address - Street 2:ROOM 311
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2070
Practice Address - Country:US
Practice Address - Phone:414-616-8805
Practice Address - Fax:414-616-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251C00000X251C00000X
WI39773300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40923200Medicaid
WI39142000Medicaid
WI39611700Medicaid
WI39773300Medicaid
WI39274900Medicaid
WI40988100Medicaid
WI42233800Medicaid
WI43705500Medicaid
WI39281100Medicaid
WI42233821Medicaid