Organization
DEEP HEALING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLY MARIE WITKOWIAK LCSW (CO-OWNER)
(414) 899-0793
Entity
Organization
Contact information
Practice address
1841 N PROSPECT AVE, MILWAUKEE, WI 53202-1933
(414) 678-1558
Mailing address
1841 N PROSPECT AVE, MILWAUKEE, WI 53202-1933
(414) 678-1558
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041C0700X
—
WI
05
—
1041S0200X
—
WI
Enumeration date
05/24/2019
Last updated
05/24/2019
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