Individual
CLARISSA DETRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 437-3540
Mailing address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 437-3540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073759577
—
WI
Enumeration date
01/05/2009
Last updated
12/15/2014
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