Sacred Wings Counseling, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SACRED WINGS COUNSELING, LLC

Practice address

826 SW Main Blvd Ste 102
Lake City, FL 32025-5742

Phone

(386) 984-5366

Fax

(386) 287-6525

NPI assigned

Sep 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda Manske, LCSW, RPT

Title

Mental Health Therapist

Phone

(386) 984-5366

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1205613445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 SW STORY PL",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320241101",
            "telephone_number": "386-984-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 SW MAIN BLVD STE 102",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320255742",
            "telephone_number": "386-984-5366",
            "fax_number": "386-287-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED WINGS COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "MANSKE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "386-984-5366",
        "authorized_official_credential": "LCSW, RPT"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Renee Russell, MS CCC-SLP
• Michelle Russo
• Jung Ho Ryu, PHD
• Pedro Alberto Sabillon, LPN
• Sacred Mind Psychiatry LLC
• Jean Denis Saintvil, SPEECH THERAPIST-CF
• Salem Homes of Florida, Inc. (Spring Street Group Home)
• Salem Villages MRDD, Inc.
• Rigen Pamin Saltivan, OD
• James Alvin Salyers, RN

• Clinical Social Worker in Lake City, FL
• Providers in Lake City, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.