Individual
TONYA ILIAH WITHERSPOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2222
Mailing address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2222
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16327-132
WI
101YP2500X
Professional Counselor
Primary
6978-125
WI
Other
Enumeration date
12/18/2018
Last updated
10/08/2019
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