Individual
MRS. CARMEN A GUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT, IDP-AT
Contact information
Practice address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6612
Mailing address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6612
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20545-130
WI
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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