| Sacred Wings Counseling, Llc | |
|
826 Sw Main Blvd Ste 102 Lake City FL 32025-5742 | |
| (386) 984-5366 | |
| (386) 287-6525 |
| Full Name | Sacred Wings Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 826 Sw Main Blvd Ste 102, Lake City, Florida |
| Authorized Official Name and Position | Amanda Manske (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 3869845366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Wings Counseling, Llc 184 Sw Story Pl Lake City FL 32024-1101 Ph: (386) 984-5366 | Sacred Wings Counseling, Llc 826 Sw Main Blvd Ste 102 Lake City FL 32025-5742 Ph: (386) 984-5366 |
| NPI Number | 1205613445 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 2062868177 |
|---|---|
| Medicare Enrollment ID | O20231026000437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205613445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amanda Manske |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649985334 PECOS PAC ID: 3971959081 Enrollment ID: I20231108000036 |
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