Individual
LA SHANDA TOLEFREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, MS
Contact information
Practice address
3536 52ND ST, KENOSHA, WI 53144-2662
(262) 842-0538
(262) 842-0539
Mailing address
3536 52ND ST, KENOSHA, WI 53144-2662
(262) 842-0538
(262) 842-0539
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17018131
WI
101YM0800X
Mental Health Counselor
8095-125
WI
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100227567
—
WI
01
—
17018131
SUBSTANCE ABUSE COUNSELOR
WI
01
—
8095125
LICENSED PROFESSIONAL COUNSELOR
WI
Enumeration date
12/05/2016
Last updated
05/14/2024
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