Individual
MRS. STACI JAN WISEMILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-P
Contact information
Practice address
2313 EXECUTIVE CIR, SUITE C, GREENVILLE, NC 27834-3744
(252) 215-5700
(252) 215-5701
Mailing address
2313 EXECUTIVE CIRCLE, SUITE C, GREENVILLE, NC 27834
(252) 215-5700
(252) 215-5701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/05/2011
Last updated
09/09/2013
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