Individual
HOLLISTER L JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., SAC-IT
Contact information
Practice address
400 W RIVER DR, WEST BEND, WI 53090-1518
(262) 334-4340
Mailing address
6223 W STEVENSON ST, MILWAUKEE, WI 53213-4163
(414) 587-2212
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19467
WI
101YM0800X
Mental Health Counselor
Primary
—
WI
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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