Individual
DANIELLE LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA,CADC,QMHP
Contact information
Practice address
106 EDWARDS ST, NEWTON, IL 62448-1736
(618) 783-4154
Mailing address
106 EDWARDS ST, NEWTON, IL 62448-1736
(618) 783-4154
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/10/2020
Last updated
06/20/2024
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