Provider Demographics
NPI:1700694197
Name:J&M WISDOM WEAVERS COUNSELING LLC
Entity type:Organization
Organization Name:J&M WISDOM WEAVERS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-817-0121
Mailing Address - Street 1:4415 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:233-877-3661
Practice Address - Street 1:4415 BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3468
Practice Address - Country:US
Practice Address - Phone:717-817-0121
Practice Address - Fax:233-877-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty