Provider Demographics
NPI:1578977583
Name:FOUNDATIONS, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-488-8848
Mailing Address - Street 1:145 S SANTA CLAUS LN
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7702
Mailing Address - Country:US
Mailing Address - Phone:907-488-8848
Mailing Address - Fax:907-488-0695
Practice Address - Street 1:145 S SANTA CLAUS LN
Practice Address - Street 2:UNIT 2
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7702
Practice Address - Country:US
Practice Address - Phone:907-488-8848
Practice Address - Fax:907-488-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK610251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health