Organization
CITY TRANSFORMATION, LIMITED
Active
Other names
City Transformation Clinic North
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA ANTHONY CLINICAL SUPERVISOR (EXECUTIVE DIRECTOR)
(414) 616-9744
Entity
Organization
Contact information
Practice address
6815 W CAPITOL DR STE 301, MILWAUKEE, WI 53216-2056
(414) 616-9744
(414) 616-9747
Mailing address
6815 W CAPITOL DR STE 301, MILWAUKEE, WI 53216-2056
(414) 616-9744
(414) 616-9747
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2918
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193400000X
—
WI
Enumeration date
09/30/2010
Last updated
09/30/2010
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