Individual
MR. CORIE HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC-III
Contact information
Practice address
2405 NORTHWESTERN AVE # LL15, RACINE, WI 53404-2534
(262) 260-8370
(262) 260-8538
Mailing address
1625 DERBY AVE, RACINE, WI 53403-3808
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13772
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39173200
—
WI
Enumeration date
01/30/2007
Last updated
12/06/2012
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