1821437310 NPI number — MRS. GIOVANNA ANDRIA WISE LPC

Table of content: MRS. GIOVANNA ANDRIA WISE LPC (NPI 1821437310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821437310 NPI number — MRS. GIOVANNA ANDRIA WISE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISE
Provider First Name:
GIOVANNA
Provider Middle Name:
ANDRIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
GIOVANNA
Provider Other Middle Name:
ANDRIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821437310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 W 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48503-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-496-5105
Provider Business Mailing Address Fax Number:
810-496-4922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48503-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-496-4936
Provider Business Practice Location Address Fax Number:
810-496-4922
Provider Enumeration Date:
06/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6802087261 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6401013998 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)