Organization
JASON L. FAIRWEATHER
Active
Other names
Walk of Life Counseling, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JASON LEE FAIRWEATHER LPCIT, SACIT (OWNER)
(920) 204-6590
Entity
Organization
Contact information
Practice address
553 BROADWAY, BERLIN, WI 54923-1323
(920) 204-6590
Mailing address
553 BROADWAY, BERLIN, WI 54923-1323
(920) 204-6590
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
01/07/2021
Last updated
01/12/2021
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