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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