Individual
MR. CHARLES D LIPFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
220 E LA CROSSE ST., JUNEAU COUNTY HUMAN SERVICES, MAUSTON, WI 53948-2101
(608) 847-2400
(608) 847-9599
Mailing address
220 E LA CROSSE ST., JUNEAU COUNTY HUMAN SERVICES, MAUSTON, WI 53948-2101
(608) 847-2400
(608) 847-9599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15413-131
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
302375
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003079708
—
WI
Enumeration date
07/03/2008
Last updated
06/30/2009
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