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Individual

MELISSA A DETRIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, SAC-IT

Contact information

Practice address
2640 W POINT RD, GREEN BAY, WI 54304-1344
(920) 490-3875
Mailing address
1566 W MASON ST STE 5, GREEN BAY, WI 54303-2274
(920) 212-1612

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20395-130
WI
101YP2500X
Professional Counselor
Primary
11880-125
WI
101YP2500X
Professional Counselor
6401225600
MI

Other

Enumeration date
05/08/2023
Last updated
04/17/2026
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