Provider Demographics
NPI:1659535474
Name:HEALING AND REFUGE CENTRE
Entity Type:Organization
Organization Name:HEALING AND REFUGE CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EARNESTINE
Authorized Official - Middle Name:'LAMONICA'
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-293-9869
Mailing Address - Street 1:3110 E KITE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3034
Mailing Address - Country:US
Mailing Address - Phone:316-293-9869
Mailing Address - Fax:
Practice Address - Street 1:3110 E KITE CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3034
Practice Address - Country:US
Practice Address - Phone:316-293-9869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3804251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1730125964OtherINDIVIDUAL NPI