Sacred Wings Counseling, Llc | |
826 Sw Main Blvd Ste 102 Lake City FL 32025-5742 | |
(386) 984-5366 | |
(386) 287-6525 |
Full Name | Sacred Wings Counseling, Llc |
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Speciality | Social Worker |
Location | 826 Sw Main Blvd Ste 102, Lake City, Florida |
Authorized Official Name and Position | Amanda Manske (MENTAL HEALTH THERAPIST) |
Authorized Official Contact | 3869845366 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Sacred Wings Counseling, Llc 184 Sw Story Pl Lake City FL 32024-1101 Ph: (386) 984-5366 | Sacred Wings Counseling, Llc 826 Sw Main Blvd Ste 102 Lake City FL 32025-5742 Ph: (386) 984-5366 |
NPI Number | 1205613445 |
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Provider Enumeration Date | 09/12/2023 |
Last Update Date | 09/12/2023 |
Certification Date | 09/12/2023 |
Medicare PECOS PAC ID | 2062868177 |
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Medicare Enrollment ID | O20231026000437 |
Identifier | Type | State | Issuer |
---|---|---|---|
1205613445 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Amanda Manske |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1649985334 PECOS PAC ID: 3971959081 Enrollment ID: I20231108000036 |
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