Organization
QAM
Active
Other names
Racine Comprehensive Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MASON (CLINIC DIRECTOR)
(262) 598-1392
Entity
Organization
Contact information
Practice address
5735 DURAND AVE, A, RACINE, WI 53406-5011
(262) 598-1392
(262) 598-1395
Mailing address
5735 DURAND AVE, A, RACINE, WI 53406-5011
(262) 598-1392
(262) 598-1395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15532-132
WI
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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