Individual
CHARLES T WISNESKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSWLCSW
Contact information
Practice address
703 S MAIN ST STE 5, COTTONWOOD, AZ 86326-4615
(928) 634-0964
(928) 649-6852
Mailing address
515 CASNER DR, CLARKDALE, AZ 86324-3619
(928) 634-0964
(928) 649-6852
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-0714
AZ
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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