Organization
GATEWAY TO CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUIN O GARRETT MS,CSW,CSAC,CCS (CLINICAL SUPERVISOR)
(414) 442-2033
Entity
Organization
Contact information
Practice address
2319 W CAPITOL DR, MILWAUKEE, WI 53206-1919
(414) 442-2033
Mailing address
2319 W CAPITOL DR, MILWAUKEE, WI 53206-1919
(414) 442-2033
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
396006491
WI
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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