| Lavender Skies Counseling Llc | |
|
1794 Allouez Ave. Suite C, Number 243 Green Bay WI 54311-6281 | |
| (920) 367-4025 | |
| Not Available |
| Full Name | Lavender Skies Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 1794 Allouez Ave., Green Bay, Wisconsin |
| Authorized Official Name and Position | Cindy L Fonseca (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 9203674025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavender Skies Counseling Llc 1794 Allouez Ave. Suite C, Number 243 Green Bay WI 54311 Ph: (920) 367-4025 | Lavender Skies Counseling Llc 1794 Allouez Ave. Suite C, Number 243 Green Bay WI 54311-6281 Ph: (920) 367-4025 |
| NPI Number | 1235990698 |
|---|---|
| Provider Enumeration Date | 01/22/2024 |
| Last Update Date | 03/14/2024 |
| Certification Date | 02/12/2024 |
| Medicare PECOS PAC ID | 5597101683 |
|---|---|
| Medicare Enrollment ID | O20240312001122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235990698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Cindy L Fonseca-shivers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700165867 PECOS PAC ID: 3971753963 Enrollment ID: I20240314002058 |
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