Individual
TINA SANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12645 W BURLEIGH RD STE 19, BROOKFIELD, WI 53005-3102
(262) 432-0670
(262) 475-0412
Mailing address
12645 W BURLEIGH RD STE 19, BROOKFIELD, WI 53005-3102
(262) 432-0670
(262) 475-0412
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11442-125
WI
101YP2500X
Professional Counselor
Primary
11442-125
WI
Other
Enumeration date
08/23/2016
Last updated
12/19/2024
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