Individual
MRS. MICHELLE L WAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAC, LPC, CSAC
Contact information
Practice address
1270 MAIN ST STE 120, GREEN BAY, WI 54302-1337
(920) 288-2846
(920) 770-4153
Mailing address
1270 MAIN ST STE 120, GREEN BAY, WI 54302-1337
(920) 288-2846
(920) 770-4153
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
8568-125
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
16594-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095134
—
WI
Enumeration date
11/12/2019
Last updated
11/16/2022
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