Individual
FANCHEN GAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCIT
Contact information
Practice address
1971 WASHINGTON ST STE 200, GRAFTON, WI 53024-2125
(262) 377-6276
(262) 377-6289
Mailing address
4848 N LYDELL AVE APT 125, MILWAUKEE, WI 53217-5851
(414) 399-2788
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
19275-130
WI
101YM0800X
Mental Health Counselor
4887-226
WI
101YP2500X
Professional Counselor
Primary
4887-226
WI
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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