Individual
TINA MARIE BAETEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2920 S WEBSTER AVE STE B, GREEN BAY, WI 54301-1594
(920) 632-4471
(920) 632-4315
Mailing address
1090 S TAMIAMI TRL, SARASOTA, FL 34236-9116
(904) 605-4986
(941) 460-5599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13791
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39382000
—
WI
Enumeration date
01/09/2007
Last updated
12/06/2022
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