| NPI | 1558593129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID DIANN HICKS Clinical & Executive Director 414-933-7083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15226-130) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1198) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2009-08-17 |