Provider Demographics
NPI:1518101807
Name:MENDING WINGS INC
Entity Type:Organization
Organization Name:MENDING WINGS INC
Other - Org Name:MENDING WINGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:TOMIKA
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, CMHP
Authorized Official - Phone:404-441-2379
Mailing Address - Street 1:1138 VIZCAYA LAKES RD
Mailing Address - Street 2:APT 104
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-6957
Mailing Address - Country:US
Mailing Address - Phone:404-441-2379
Mailing Address - Fax:407-297-8779
Practice Address - Street 1:1138 VIZCAYA LAKES RD
Practice Address - Street 2:APT 104
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6957
Practice Address - Country:US
Practice Address - Phone:404-441-2379
Practice Address - Fax:407-297-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty