Individual
JOAN E WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CAC III
Contact information
Practice address
310 W C ST, PUEBLO, CO 81003-3409
(719) 296-1366
(719) 296-6825
Mailing address
310 W C ST, PUEBLO, CO 81003-3409
(719) 296-1366
(719) 296-6825
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2935
CO
Other
Enumeration date
03/24/2009
Last updated
03/24/2009
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