Individual
MRS. ORLESIA GAY GOOSEBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC AND SOCIAL WORK
Contact information
Practice address
1501 ALBERT ST, NORTH UNIT UPPER, RACINE, WI 53404-2713
(262) 638-2975
Mailing address
7726 W LISBON AVE, APT # 2, MILWAUKEE, WI 53222-3945
(414) 617-3684
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15709-132
WI
103K00000X
Behavior Analyst
10901-120
WI
Other
Enumeration date
08/16/2012
Last updated
09/11/2012
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