Individual
STACEY L DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, SAC-T
Contact information
Practice address
3173 SHERMAN PARC CIR, JACKSON, WI 53037-8954
(414) 491-2140
Mailing address
3173 SHERMAN PARC CIR, JACKSON, WI 53037-8954
(414) 491-2140
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16529-130
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
7889-123
WI
Other
Enumeration date
02/21/2012
Last updated
04/17/2013
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