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Organization
DIFFERENT SHADES OF HEALING, LLC
Active
Organization
DIFFERENT SHADES OF HEALING, LLC
Active
Other names
Different Shades of Healing
Organization subpart
No
Provider details
NPI number
Authorized official
NASTASSIA JACKSON LPC-IT (THERAPIST/OWNER)
(414) 265-6156
Entity
Organization
Contact information
Practice address
6830 W VILLARD AVE STE 190, MILWAUKEE, WI 53218-3968
(262) 320-7886
Mailing address
4752 N 78TH CT, MILWAUKEE, WI 53218-4643
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071680
—
WI
Enumeration date
04/16/2019
Last updated
04/16/2019
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