Provider Demographics
NPI:1013691344
Name:WINGSPAN COUNSELING LCSW PLLC
Entity Type:Organization
Organization Name:WINGSPAN COUNSELING LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORIGINAL MEMBER/MANAGER/ LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MATTSSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:585-568-7864
Mailing Address - Street 1:95 ALLENS CREEK RD STE 9
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3252
Mailing Address - Country:US
Mailing Address - Phone:585-568-7864
Mailing Address - Fax:855-523-1669
Practice Address - Street 1:95 ALLENS CREEK RD STE 9
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3252
Practice Address - Country:US
Practice Address - Phone:585-568-7864
Practice Address - Fax:855-523-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty