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Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2917
WI
101YP2500X
Professional Counselor
Primary
2917
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39349400
—
WI
Enumeration date
—
Last updated
—
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