Individual
STACEY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC IT
Contact information
Practice address
3900 W BROWN DEER RD STE 200, BROWN DEER, WI 53209-1220
(414) 540-2170
Mailing address
611A N 62ND ST, WAUWATOSA, WI 53213-4171
(414) 346-6423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
18842-130
WI
101YP2500X
Professional Counselor
Primary
7088-226
WI
Other
Enumeration date
04/11/2019
Last updated
09/13/2022
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