Organization
INTEGRATED COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSONNA SUE COMERS LCSW (OWNER)
(920) 929-9140
Entity
Organization
Contact information
Practice address
N6687 WRIGHTWAY DR STE D, FOND DU LAC, WI 54937-8433
(920) 929-9140
(920) 929-9142
Mailing address
N6687 WRIGHTWAY DR STE D, FOND DU LAC, WI 54937-8433
(920) 929-9140
(920) 929-9142
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
29-036
WI
103TC0700X
Clinical Psychologist
2270-057
WI
1041C0700X
Clinical Social Worker
Primary
7003-123
WI
1041C0700X
Clinical Social Worker
7209-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
422-43800
—
WI
Enumeration date
06/22/2009
Last updated
06/22/2009
Update your record
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