Individual
CALVIN JAMES BRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
151 E BADGER RD, SUITE A, MADISON, WI 53713-2708
(608) 250-2512
(608) 250-2516
Mailing address
151 E BADGER RD, SUITE A, MADISON, WI 53713-2708
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17156-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629282470
EMPLOYER IDENTIFICATION
WI
Enumeration date
01/11/2016
Last updated
01/11/2016
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