Organization
A VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA GROSS (OWNER)
(920) 809-6766
Entity
Organization
Contact information
Practice address
2031 E CALUMET ST, APPLETON, WI 54915-4742
(920) 809-6766
Mailing address
PO BOX 172, APPLETON, WI 54912-0172
(920) 809-6766
(561) 282-3238
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/04/2019
Last updated
03/04/2019
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