| NPI | 1124104740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN A. WOLF Clinical Director 262-652-2406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 2657) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 2657) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2008-06-30 |