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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
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