Provider Demographics
NPI:1881301471
Name:SAGE WISDOM COUNSELING LLC
Entity type:Organization
Organization Name:SAGE WISDOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADOUSIER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:209-628-0176
Mailing Address - Street 1:127 E LIBERTY ST STE 375
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5002
Mailing Address - Country:US
Mailing Address - Phone:330-800-5471
Mailing Address - Fax:
Practice Address - Street 1:3214 W HUTTON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-9040
Practice Address - Country:US
Practice Address - Phone:209-628-0176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty