Provider Demographics
NPI:1912243288
Name:SANKOFA BEHAVIORAL & COMMUNITY HEALTH, INC
Entity Type:Organization
Organization Name:SANKOFA BEHAVIORAL & COMMUNITY HEALTH, INC
Other - Org Name:SANKOFABCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CLINICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:414-202-9146
Mailing Address - Street 1:2810 CROSSROADS DR
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-7942
Mailing Address - Country:US
Mailing Address - Phone:414-202-9146
Mailing Address - Fax:
Practice Address - Street 1:2810 CROSSROADS DR
Practice Address - Street 2:SUITE 4000
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7942
Practice Address - Country:US
Practice Address - Phone:414-202-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 103T00000X, 103TC1900X, 251B00000X, 251S00000X
WI3010251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty