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Individual
FRED JONES
Active
Individual
FRED JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCIII, LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151
WI
101YP2500X
Professional Counselor
Primary
3220-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151
CADCIII
WI
01
—
3220-125
LPC
WI
05
—
39736200
—
WI
Enumeration date
10/17/2006
Last updated
08/03/2018
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