Individual
BRADLEY G. WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICDC-CS
Contact information
Practice address
1150 N MAIN ST, MANSFIELD, OH 44903-9718
(419) 526-2000
(419) 524-8022
Mailing address
PO BOX 788, MANSFIELD, OH 44901-0788
(419) 526-2000
(419) 524-8022
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
954172
OH
Other
Enumeration date
06/19/2014
Last updated
06/19/2014
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