Provider Demographics
NPI:1760670400
Name:WISEKIDZ LEARNING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WISEKIDZ LEARNING SOLUTIONS, LLC
Other - Org Name:WISEKIDZ ACT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT/EDUCATIONAL THERAPIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:K. NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-598-5619
Mailing Address - Street 1:3510 W STEWARTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2471
Mailing Address - Country:US
Mailing Address - Phone:770-947-6118
Mailing Address - Fax:770-949-4069
Practice Address - Street 1:3510 W STEWARTS MILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2471
Practice Address - Country:US
Practice Address - Phone:770-947-6118
Practice Address - Fax:770-949-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty