Provider Demographics
NPI:1598267288
Name:WISE WILLOW COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:WISE WILLOW COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBEY-ZERKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-277-9617
Mailing Address - Street 1:2875 NORTHWIND DR STE 215
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5035
Mailing Address - Country:US
Mailing Address - Phone:989-277-9617
Mailing Address - Fax:517-882-6181
Practice Address - Street 1:2875 NORTHWIND DR STE 215
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:989-277-9617
Practice Address - Fax:517-882-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty