Basic Information
| Provider Information | |||||||||
| NPI: | 1184241036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGE COUNSELING AND WELLNESS SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5144 SADDLECREEK RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436232733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193500474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1705 INDIAN WOOD CIR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435374046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199697243 | ||||||||
| FaxNumber: | 4197401977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2020 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | NOVISKI | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
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| AuthorizedOfficialTitleorPosition: | THERAPIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4193500474 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPCC | ||||||||
| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.