Provider Demographics
NPI:1427329085
Name:WISDOM FOR LIVING,.INC.
Entity type:Organization
Organization Name:WISDOM FOR LIVING,.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANKORLAAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-946-3341
Mailing Address - Street 1:40124 HIGHWAY 27
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5905
Mailing Address - Country:US
Mailing Address - Phone:863-421-7069
Mailing Address - Fax:863-422-3275
Practice Address - Street 1:1420 CELEBRATION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5159
Practice Address - Country:US
Practice Address - Phone:863-421-7069
Practice Address - Fax:863-422-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4228251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health