Provider Demographics
NPI:1689993800
Name:SPADE'S COUNSELING AGENCY
Entity Type:Organization
Organization Name:SPADE'S COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SPADE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:906-864-9830
Mailing Address - Street 1:621 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-3229
Mailing Address - Country:US
Mailing Address - Phone:906-864-9830
Mailing Address - Fax:906-864-9831
Practice Address - Street 1:621 1ST ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3229
Practice Address - Country:US
Practice Address - Phone:906-864-9830
Practice Address - Fax:906-864-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4388125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health