Provider Demographics
NPI:1851738009
Name:IMANI COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:IMANI COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:414-737-1820
Mailing Address - Street 1:13500 W CAPITOL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2444
Mailing Address - Country:US
Mailing Address - Phone:414-737-1820
Mailing Address - Fax:414-455-5405
Practice Address - Street 1:13500 W CAPITOL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2444
Practice Address - Country:US
Practice Address - Phone:414-737-1820
Practice Address - Fax:414-455-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI413-7125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty