Provider Demographics
NPI:1881879922
Name:WISDOM TRADITIONS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:WISDOM TRADITIONS COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEMOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:907-562-4540
Mailing Address - Street 1:401 W INTERNATIONAL RD
Mailing Address - Street 2:STE 17
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1181
Mailing Address - Country:US
Mailing Address - Phone:907-770-3656
Mailing Address - Fax:
Practice Address - Street 1:401 W INTERNATIONAL RD STE 27
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1168
Practice Address - Country:US
Practice Address - Phone:907-562-4540
Practice Address - Fax:907-562-4502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISDOM TRADITIONS COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-08
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder