Individual
MOLLEA ROSEANNA GREYLORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
423 PINE TREE DR, FOND DU LAC, WI 54935-5474
(920) 948-9741
Mailing address
423 PINE TREE DR, FOND DU LAC, WI 54935-5474
(920) 948-9741
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19365-130
WI
Other
Enumeration date
08/11/2021
Last updated
08/12/2021
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