Provider Demographics
NPI:1912161241
Name:WINGS OF DOVE COUNSELING SERVICE LLC
Entity type:Organization
Organization Name:WINGS OF DOVE COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WYONNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LCSW
Authorized Official - Phone:414-324-4999
Mailing Address - Street 1:230 W WELLS ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1866
Mailing Address - Country:US
Mailing Address - Phone:414-324-4999
Mailing Address - Fax:414-276-6819
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:SUITE 309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-324-4999
Practice Address - Fax:414-276-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty