Individual
TIAKA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5226 PLANET DR, LOUISVILLE, KY 40258-3341
(502) 299-1319
Mailing address
5226 PLANET DR, LOUISVILLE, KY 40258-3341
(502) 299-1319
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
280644
KY
106H00000X
Marriage & Family Therapist
Primary
280644
KY
Other
Enumeration date
09/22/2022
Last updated
12/03/2024
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