Individual
MS. CHRISTINE T LE GRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, ATRL-BC
Contact information
Practice address
6789 N GREEN BAY RD, GLENDALE, WI 53209-3472
(414) 828-1856
Mailing address
5948 N SANTA MONICA BLVD, WHITEFISH BAY, WI 53217-4618
(414) 828-1856
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
59-136
WI
101YP2500X
Professional Counselor
Primary
3878-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40948900
—
WI
Enumeration date
02/15/2007
Last updated
09/18/2009
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