Organization
DIVERSE CLINICAL SERVICES ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASILISA VIRELLA PH.D. (DIRECTOR)
(414) 347-7063
Entity
Organization
Contact information
Practice address
633 W WISCONSIN AVE, SUITE 330, MILWAUKEE, WI 53203-1918
(414) 347-4063
(414) 347-4075
Mailing address
633 W WISCONSIN AVE, SUITE 330, MILWAUKEE, WI 53203-1918
(414) 347-4063
(414) 347-4075
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
2692-123
WI
2084P0800X
Psychiatry Physician
Primary
27318020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31786300
—
WI
05
—
39704500
—
WI
05
—
42206700
—
WI
Enumeration date
09/02/2006
Last updated
09/11/2025
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