# DIFFERENT SHADES OF HEALING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Different Shades of Healing
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033772058
- **Authorized official:** NASTASSIA JACKSON LPC-IT (THERAPIST/OWNER)
- **Authorized official phone:** (414) 265-6156

## Contact information

- **Practice address:** 6830 W VILLARD AVE STE 190, MILWAUKEE, WI 53218-3968
- **Practice address phone:** (262) 320-7886
- **Mailing address:** 4752 N 78TH CT, MILWAUKEE, WI 53218-4643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | — | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 04/16/2019
- **Last updated:** 04/16/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100071680 | — | WI |