Organization
TEEN MOMS WELLNESS PNCC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE HATCHETT (CEO)
(262) 218-1249
Entity
Organization
Contact information
Practice address
9713 W LISBON AVE, MILWAUKEE, WI 53222-2533
(414) 630-4463
Mailing address
9713 W LISBON AVE, MILWAUKEE, WI 53222-2533
(262) 218-1249
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/26/2022
Last updated
03/11/2022
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