Provider Demographics
NPI:1578339271
Name:WILLENIUM ENTERPRISE FOUNDATION
Entity Type:Organization
Organization Name:WILLENIUM ENTERPRISE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAKRISTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-615-6542
Mailing Address - Street 1:6915 ROCK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-2416
Mailing Address - Country:US
Mailing Address - Phone:502-615-6542
Mailing Address - Fax:
Practice Address - Street 1:3401 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-5015
Practice Address - Country:US
Practice Address - Phone:502-615-6542
Practice Address - Fax:502-331-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health