Provider Demographics
NPI:1942607585
Name:WINTERS-WALLACE, KADEITRA MONTEIL (LPC)
Entity Type:Individual
Prefix:
First Name:KADEITRA
Middle Name:MONTEIL
Last Name:WINTERS-WALLACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 N OAKLAND AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4340
Mailing Address - Country:US
Mailing Address - Phone:414-739-6476
Mailing Address - Fax:480-307-9771
Practice Address - Street 1:2425 N OAKLAND AVE APT 207
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4340
Practice Address - Country:US
Practice Address - Phone:414-739-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16640-130101YA0400X
247200000X
WI10037-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other