# DEEP HEALING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700443744
- **Authorized official:** ASHLY MARIE WITKOWIAK LCSW (CO-OWNER)
- **Authorized official phone:** (414) 899-0793

## Contact information

- **Practice address:** 1841 N PROSPECT AVE, MILWAUKEE, WI 53202-1933
- **Practice address phone:** (414) 678-1558
- **Mailing address:** 1841 N PROSPECT AVE, MILWAUKEE, WI 53202-1933
- **Mailing address phone:** (414) 678-1558

## Taxonomy

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

## Other

- **Enumeration date:** 05/24/2019
- **Last updated:** 05/24/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1041C0700X | — | WI |
| 05 | — | 1041S0200X | — | WI |