Organization
CHILD, MARRIAGE & FAMILY THERAPY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON L JOHNSON VISOR LCSW (OWNER)
(262) 886-8702
Entity
Organization
Contact information
Practice address
6939 MARINER DR, SUITE C, RACINE, WI 53406-3938
(262) 886-8702
(262) 886-8714
Mailing address
6939 MARINER DR, SUITE C, RACINE, WI 53406-3938
(262) 886-8702
(262) 886-8714
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1035-132
WI
101YP2500X
Professional Counselor
1012-125
WI
101YP2500X
Professional Counselor
Primary
369-125
WI
101YP2500X
Professional Counselor
521-126
WI
101YP2500X
Professional Counselor
947-125
WI
1041C0700X
Clinical Social Worker
2031-123
WI
1041C0700X
Clinical Social Worker
2254-123
WI
Other
Enumeration date
03/21/2007
Last updated
06/16/2010
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