Organization
THE EVOLVING CHAIR COUNSELING AND CONSULTING AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAKIESHA RUSSELL LPC (PRESIDENT/CHILD & FAMILY THERAPIST)
(414) 395-0037
Entity
Organization
Contact information
Practice address
3100 N 78TH ST, MILWAUKEE, WI 53222-3916
(414) 395-0037
Mailing address
7425 W FLORIST AVE, MILWAUKEE, WI 53218-1850
(414) 748-1614
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
6098-125
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
6098-125
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
6098-125
WI
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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