Provider Demographics
NPI:1821437310
Name:WISE, GIOVANNA ANDRIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GIOVANNA
Middle Name:ANDRIA
Last Name:WISE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:GIOVANNA
Other - Middle Name:ANDRIA
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, LPC
Mailing Address - Street 1:420 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2445
Mailing Address - Country:US
Mailing Address - Phone:810-496-5105
Mailing Address - Fax:810-496-4922
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-496-4936
Practice Address - Fax:810-496-4922
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087261104100000X
MI6401013998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker