Organization
INNER AWAKENINGS DIAGNOSTIC AND COUNSELING CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELISSA A FORD MS,LPC (OWNER)
(262) 691-2581
Entity
Organization
Contact information
Practice address
436 OAKTON AVE, PEWAUKEE, WI 53072-3542
(262) 691-2581
(262) 691-2761
Mailing address
436 OAKTON AVE, PEWAUKEE, WI 53072-3542
(262) 691-2581
(262) 691-2761
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
HFS61.91
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
HFS61.91
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42226000
—
WI
Enumeration date
05/10/2007
Last updated
02/19/2010
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